Spontaneous Remission Of Acromegaly After Pituitary Apoplexy In A Middle-aged Male
Alam, S., Kubihal, S., Goyal, A., & Jyotsna, V. P. (2021). Spontaneous Remission of Acromegaly After Pituitary Apoplexy in a Middle-Aged Male. Ochsner journal, 21(2), 194–199. https://doi.org/10.31486/toj.20.0002
View Original Source →Abstract
Background: Pituitary apoplexy results from hemorrhage, infarction, or hemorrhagic infarction within a pituitary tumor. Subclinical or clinical apoplexy is not uncommon in acromegaly, owing to the large size of the tumor at initial detection. Growth hormone excess in acromegaly often persists following surgery. However, in rare instances, pituitary apoplexy may present a spontaneous cure to growth hormone excess. Case Report: A 40-year-old male presented with holocranial headache for the past 16 years that had worsened in severity during the prior year. Two months before presentation, he experienced a severe headache that he described as the worst headache of his life. The patient had prominent acromegaloid features that he ignored, as they seemed to cause no harm. The patient had no signs of clinically active disease. Magnetic resonance imaging of the brain revealed a pituitary macroadenoma with evidence of hemorrhage. Serum insulin-like growth factor 1 and oral glucose–suppressed serum growth hormone levels were normal, suggestive of inactive or silent disease. Pituitary apoplexy causing spontaneous remission of acromegaly was diagnosed, and close follow-up was planned for the evolution of hypopituitarism. Conclusion: This case highlights a rare presentation of acromegaly in which an episode of symptomatic pituitary apoplexy revealed the diagnosis of pituitary adenoma and led to the cure of growth hormone hypersecretion.
Case Details
Disease Location
Pituitary gland
Personal Characteristics
40-year-old male, history of holocranial headaches for the past 16 years
Clinical Characteristics
Presented to our clinic with a history of holocranial headaches for the past 16 years that had gradually worsened. He had noticed acromegaloid changes in the form of coarsening facial features and an increase in the size of his hands and feet during the prior 10 years. He did not seek medical attention for these changes. Two months before the current presentation, he had an episode of severe headache that he described as the worst headache of his life. The episode lasted for 4 to 5 hours, and he was treated with intravenous analgesics and fluids. He clinical features of acromegaly were confirmed on physical examination; however, no signs of active disease were noted. Laboratory investigations suggested normal pituitary function with no evidence of growth hormone hypersecretion. MRI showed enlarged pituitary fossa, a 12-mm macroadenoma in the right half of the pituitary gland, and evidence of hemorrhage within the mass.
Remission Characteristics
Clinical and biochemical markers of acromegaly activity were normal, suggestive of inactive disease. MRI showed enlarged pituitary fossa, a 12-mm macroadenoma in the right half of the pituitary gland, and evidence of hemorrhage within the mass.
Treatment & Mechanisms
Proposed Remission Mechanisms
Pituitary apoplexy
Clinical Treatment
Oral analgesics as needed (acetaminophen)