PITUITARY APOPLEXY IN ACROMEGALY, A LONG-TERM FOLLOW-UP-STUDY IN 2 PATIENTS

Pituitary apoplexy is a serious complication in about 3% of patients w ith a pituitary adenoma. Very often, the diagnosis of a functioning or non-functioning adenoma is made in retrospect. In this report, we des cribe two patients in whom the diagnosis of acromegaly was made before the apoplexy. in one patient, surgical intervention was necessary bec ause of remaining clinical and biochemical activity; in the other pati ent conservative follow-up was pursued. Seven and nine years after apo plexy, respectively, the patients were clinically and biochemically in remission. During the follow-up, three and five years after apoplexy, respectively, the patients underwent a 10-min venous sampling procedu re for 24 hours, and the GH secretory profile was investigated with mu ltiparameter deconvolution analysis and by approximate entropy (ApEn), a scale- and model-independent regularity measure. The deconvolution analysis revealed an increased basal (nonpulsatile) GH secretion rate, while the total 24 h secretion rate was normal compared with 13 healt hy mate control subjects. ApEn was much larger for each patient than f or any control subject value, indicating markedly more irregular GH se cretion. We hypothesize that these subtle abnormalities are caused by non-specific damage as a result of the vascular insult, leading to abn ormal vascular supply, or abnormal autocrine and paracrine GH regulati on within the remaining grand. (C) 1998, Editrice Kurtis.