Defying the Scalpel: Management of Pituitary Apoplexy with Hydrocortisone
https://doi.org/10.15605/jafes.041.S1
- Author:
Lakshna Vani Nadarajan
1
;
Sarojini Devi Simanchalam
1
;
Poh Shean Wong
1
;
Hamizah Hamzah
1
;
Nor Afidah Abdul Karim
1
;
Noor Lita Adam
1
Author Information
1. Department of Medicine and Endocrinology, Hospital Tuanku Jaafar
- Publication Type:Journal Article
- MeSH:
Hydrocortisone;
Pituitary Apoplexy
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):93-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Pituitary apoplexy is an acute endocrine emergency, as early
recognition may influence the outcomes, often presenting
with sudden headache, visual disturbances, ocular palsies,
vomiting, or altered consciousness. Given that urgent surgical decompression is a common management,
emerging evidence supports corticosteroid therapy in our
patient with significant neuro-ophthalmic deficits.
Case:A 65-year-old male with hypertension, dyslipidemia,
type 2 diabetes mellitus, chronic kidney disease stage III,
and ischemic heart disease presented with a 4-day history
of fever, vomiting, bifrontal headache, and generalized
abdominal pain. Initially, he was treated for presumed intraabdominal sepsis. On day 3 of admission, he developed
acute right-sided complete ptosis with ophthalmoplegia
involving cranial nerves III, IV, and VI. Prior to that, he
had also reduced morning erections for 6 months before
presentation. Biochemical evaluation revealed markedly
reduced total testosterone (0.33 nmol/L) with inappropriately
low–normal gonadotropins (luteinizing hormone 1.5 IU/L,
follicle-stimulating hormone 2.3 IU/L), in keeping with
secondary hypogonadism. Adrenocorticotropic hormone
was suppressed, indicating secondary adrenal insufficiency.
Thyroid function was preserved. Overall findings suggested
partial hypopituitarism. Magnetic resonance imaging
confirmed a cystic pituitary lesion measuring 1.4 × 2.6 ×
1.8 cm with cavernous sinus involvement and features of
pituitary apoplexy. His Pituitary Apoplexy Score was 4. He
was offered surgical intervention but was not keen. He was
treated with intravenous hydrocortisone, with rapid clinical
improvement, including near-complete resolution of right
eye ptosis and restoration of extraocular movements within
3 days, and was able to recover without surgery. The
hydrocortisone was gradually tapered, and the patient was
discharged well with Endocrine follow-up.
Conclusion:Timely corticosteroid therapy alone can result in rapid,
near-complete neurological recovery in pituitary apoplexy,
even with multiple cranial nerves involvement. In carefully
selected patients without visual field compromise, conservative management may safely obviate the need for urgent
surgical intervention, emphasizing the importance of early
recognition and individualized treatment strategies.
- Full text:2026080415144107240EP_A133.pdf
