P-089 Clinical Spectrum and Predictive Factors for Early Diagnosis of Pituitary Apoplexy - A Case Series

Abstract Introduction Pituitary apoplexy is an acute, potentially life-threatening condition resulting from hemorrhage or infarction within a pituitary adenoma. It presents with a wide clinical spectrum, from sudden-onset headache and visual loss to endocrine crises. This study aims to describe the clinical spectrum, identify predictive factors for early diagnosis, and highlight management strategies and outcomes in patients with pituitary apoplexy. Clinical Case We present here three cases, 2 adults who presented with acute headache and blurry vision. Subsequent brain imaging showed pituitary apoplexy. Currently are on regular endocrine follow up as a case of subclinical apoplexy for any pituitary dysfunction along with neurology and ophthalmology follow up. Third case is of a minor who presented with vision loss for 11 months in the right eye, 2 months in the left eye and headache for 2 months. No history of loss of consciousness or seizures. She did not attain puberty yet. Brain MRI showed hemorrhagic pituitary macroadenoma. She was referred to ophthalmologist for vision assessment and to neurosurgeon who advised for the earliest decompression of optic apparatus. She underwent required surgical intervention and is on regular endocrine follow up. Conclusion Pituitary apoplexy is a critical medical emergency that demands prompt medical attention, with many cases requiring urgent surgical intervention. The treatment of pituitary apoplexy requires a multidisciplinary approach, involving a team of emergency physicians, neuroradiologists, neurosurgeons, endocrinologists, and neuro-ophthalmologists. However, the ideal treatment strategy and the timing of surgical intervention continue to be debated. Administering the appropriate treatment not only has the potential to save lives but can also greatly enhance visual and cranial nerve function outcomes. The endocrine and neuro-ophthalmological outcomes of pituitary apoplexy are largely dependent on the effectiveness of management during the acute and subacute stages of the condition. Patients with severe neurological or ophthalmological dysfunctions can show significant improvement if managed properly, while those with mild symptoms may experience worse outcomes if the diagnosis is delayed or treated inappropriately.Table 1:Endocrine profile