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Knoepfelmacher M, Jacomossi A, Barros L, Apfelbaum P, Salgado LR, Pimentel F, Cukiert A, Liberman B, Nery M, Goldman J.
Serviços de Neurocirurgia e Endocrinologia do Hospital Brigadeiro, São Paulo-SP e Disciplina de Endocrinologia do Hospital das Clínicas da USP.
Pituitary apoplexy is a rare event and is more frequent in macroadenomas then in microadenomas. Tumor size is usually reduced by apoplexy but endocrine remission is very unusual. We report on 2 patients with macroadenomas who underwent endocrine remission after apoplexy. Case I: PP, a 22 years-old woman with Cushing’s disease had an MRI which showed a macroadenoma with a small supra-sellar component. While waiting surgery, she had an ictus of headache and vomiting and went progressively under remission after that. MRI after this episode suggested residual tumor and she underwent transesphenoidal exploration of the sella, where only necrotic tissue was found. She persists under remission 1 year after apoplexy. Case II: MSL, a 27 years-old acromegalic patient had an MRI showing a macroadenoma with infrasellar and suprasellar extention. While performing a LHRH stimulation test he had an ictus with headache and vomiting. CT and MRI demonstrated blood within the tumor. He was treated medically and developed diabetis insipidus. Serial MRI showed a progressive decrease in tumor size. Pre-apoplexy GH levels were 500 ng/ml and IGF1 1271 ng/ml. Nine months after apoplexy, GH levels were 0,9 ng/ml and IGF1 526 ng/ml. Despite being a rare event, endocrine remission after apoplexy may occur.