PITUITARY APOPLEXY INDUCED BY A COMBINED ANTERIOR-PITUITARY TEST - CASE-REPORT AND LITERATURE-REVIEW

We report the case of a 31-year-old woman with a pituitary adenoma who suffered symptomatic pituitary apoplexy. The patient developed a seve re headache 2 min after undergoing a combined anterior pituitary funct ion (CAP) test. Emergent computed tomography revealed a hemorrhagic pi tuitary tumor with evidence of a small subarachnoid hemorrhage. The he adache improved spontaneously within half a day. Transsphenoidal surge ry was performed 4 days later. Histologic examination demonstrated tha t the tumor was an eosinophilic adenoma with areas of diffuse hemorrha ge. Although pituitary apoplexy caused by endocrinological testing has been reported in only 28 patients, apoplexy caused by a CAP test has been reported in only 1 patient. All of the previous cases had pituita ry macroadenomas, 69% of which were involved in suprasellar extension. Non-functioning adenomas (24%) and prolactinomas (24%) were the most often affected by endocrine stimulation tests. With respect to the sti mulants of pituitary adenomas, gonadotropin-releasing hormone (76%), T SH-releasing hormone (69%), and insulin (34%) were primarily responsib le for the apoplexy. This case report with the literature review sugge sts that routine testing on pituitary function should be ordered cauti ously given the risk of possible apoplexy.