Hemorrhage into a somatotropinoma аs a first reason for examination of a patient with previously undiagnosed acromegaly and papillary thyroid cancer

Abstract

Pituitary apoplexy is a rare acute condition that can be caused by hemorrhage into the pituitary adenoma or its infarction. This is accompanied by severe headache, nausea, vomiting, photophobia, visual and oculomotor disorders, loss of consciousness, and can also lead to a decrease in the production of a number of hormones by the pituitary gland, i.e. hypopituitarism. We present a clinical case of a 42-year female patient with previously undiagnosed acromegaly and papillary thyroid cancer. The reason for the examination was clinical symptoms of pituitary apoplexy. Right hemithyroidectomy with central and lateral lymphadenectomy was performed for her papillary thyroid cancer, followed by radioactive iodine therapy due to an increased risk of cancer progression. Hemorrhage into the pituitary adenoma in this patient has led to panhypopituitarism and remission of acromegaly. Insulin-like growth factor 1 and growth hormone levels during oral glucose tolerance test were within the reference values, which made the diagnosis of acromegaly challenging.