FATAL HEMORRHAGIC NECROSIS OF A PITUITARY MACRO-ADENOMA AFTER A STIMULATION TEST

Pituitary stimulation tests are widely used to explore hypophyseal ade nomas, There are few disadvantages, although a few cases of pituitary necrosis have been published. We report a new case with a dramatic out come. A 30-year-old man with clinical signs of acromegalia and major v isual disorders was found to have a voluminous macro-adenoma of the pi tuitary gland, Thirty minutes after beginning the stimulation test, th e patient complained of major headache and experienced persistent vomi ting for several hours, Brain magnetic resonance imaging the next day did not reveal evidence of pituitary necrosis, Sudden onset coma occur red one hour later, The CT scan demonstrated hemorrhagic necrosis of t he adenoma, The patient died despite emergency surgery. Due to the ris k of hemorrhagic necrosis of a pituitary adenoma, baseline assays mag be sufficient for diagnosis in patients with clinical signs highly sug gestive of pituitary oversecretion, especially when a voluminous tumor is involved. Rigorous clinical surveillance is required after stimula tion tests.