Acromegaly remission, SIADH and pituitary function recovery after macroadenoma apoplexy

Autor: S Sarria-Estrada, Fuat Arikan, Betina Biagetti, E Sanz-Sapera
Rok vydání: 2019
Předmět:
Male
LH
Pediatrics
Hydrocortisone
Endocrinology
Diabetes and Metabolism
Infarction
Spontaneous remission
White
Hypopituitarism
Gynaecomastia
lcsh:Diseases of the endocrine glands. Clinical endocrinology
Pituitary haemorrhage
Cortisol
Dexamethasone
0302 clinical medicine
FSH
Testosterone
FT4
Podiatry
Fatigue
TSH
Concentration difficulties
Hyponatraemia
IGF1
SIADH
Headache
Pituitary apoplexy
Saline
GH
Fluid restriction
July
030220 oncology & carcinogenesis
Feet - increased size
medicine.drug
MRI
Dexamethasone suppression
ACTH stimulation
Adult
CT scan
medicine.medical_specialty
Thyroxine (T4)
030209 endocrinology & metabolism
03 medical and health sciences
Pituitary adenoma
Fluid repletion
Acromegaly
Internal Medicine
medicine
Glucocorticoids
lcsh:RC648-665
business.industry
Sodium
medicine.disease
Antidiuretic Hormone
Unique/Unexpected Symptoms or Presentations of a Disease
Hypertonic saline
Pituitary
Spain
business
Serum osmolality
Zdroj: Endocrinology, Diabetes & Metabolism Case Reports
Endocrinology, Diabetes & Metabolism Case Reports, Vol 1, Iss 1, Pp 1-5 (2019)
ISSN: 2052-0573
Popis: Summary Pituitary apoplexy is a rare but potentially life-threatening clinical syndrome characterised by ischaemic infarction or haemorrhage into a pituitary tumour that can lead to spontaneous remission of hormonal hypersecretion. We report the case of a 50-year-old man who attended the emergency department for sudden onset of headache. A computed tomography (CT) scan at admission revealed pituitary haemorrhage and the blood test confirmed the clinical suspicion of acromegaly and an associated hypopituitarism. The T1-weighted magnetic resonance imaging (MRI) showed the classic pituitary ring sign on the right side of the pituitary. Following admission, he developed acute-onset hyponatraemia that required hypertonic saline administration, improving progressively. Surprisingly, during the follow-up, IGF1 levels became normal and he progressively recovered pituitary function. Learning points: Patients with pituitary apoplexy may have spontaneous remission of hormonal hypersecretion. If it is not an emergency, we should delay a decision to undertake surgery following apoplexy and re-evaluate hormone secretion. Hyponatraemia is an acute sign of hypocortisolism in pituitary apoplexy. However, SIADH although uncommon, could appear later as a consequence of direct hypothalamic insult and requires active and individualised treatment. For this reason, closely monitoring sodium at the beginning of the episode and throughout the first week is advisable to guard against SIADH. Despite being less frequent, if pituitary apoplexy is limited to the tumour, the patient can recover pituitary function previously damaged by the undiagnosed macroadenoma.
Databáze: OpenAIRE
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