Pituitary apoplexy after thyrotropin-releasing hormone stimulation test in a patient with pituitary macroadenoma.
Pituitary apoplexy is a rare complication of pituitary tumors. We report a case of a 41-year-old female with acromegaly due to a pituitary macroadenoma, who developed pituitary apoplexy after a thyrotropin-releasing hormone (TRH) 200 microgram intravenous injection stimulation test. Neither emergency computed tomography (CT) scans nor magnetic resonance imaging (MRI), performed 6 hours and 12 hours, respectively, after the active episode, disclosed the evidence of acute hemorrhage or infarction. Two days later, the pituitary mass, removed by transsphenoidal approach, showed ischemic necrosis and acute hemorrhage. The TRH test is generally safe for evaluating pituitary function, but pituitary apoplexy may occur after the procedure. CT and MRI may miss the diagnosis of pituitary apoplexy, especially if performed immediately after the acute episode.
Wang
Huei-Fang
HF
Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Huang
Chia-Chang
CC
Chen
Yu-Fang
YF
Ho
Donald Ming-Tak
DM
Lin
Hong-Da
HD
D000236:Adenoma / Q000150:complications*; D000328:Adult; D005260:Female; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D010899:Pituitary Apoplexy / Q000209:etiology*; D010901:Pituitary Function Tests / Q000009:adverse effects*; D010911:Pituitary Neoplasms / Q000150:complications*; D013973:Thyrotropin-Releasing Hormone
D019382:Human Growth Hormone; D013973:Thyrotropin-Releasing Hormone