Spontaneous Remission of Acromegaly After Pituitary Apoplexy in a Middle-Aged Male

Abstract

Background: Pituitary apoplexy results from hemorrhage, infarction, or hemorrhagic infarction within a pituitary tumor. Subclinical or clinical apoplexy is not uncommon in acromegaly, owing to the large size of the tumor at initial detection. Growth hormone excess in acromegaly often persists following surgery. However, in rare instances, pituitary apoplexy may present a spontaneous cure to growth hormone excess. Case Report: A 40-year-old male presented with holocranial headache for the past 16 years that had worsened in severity during the prior year. Two months before presentation, he experienced a severe headache that he described as the worst headache of his life. The patient had prominent acromegaloid features that he ignored, as they seemed to cause no harm. The patient had no signs of clinically active disease. Magnetic resonance imaging of the brain revealed a pituitary macroadenoma with evidence of hemorrhage. Serum insulin-like growth factor 1 and oral glucose-suppressed serum growth hormone levels were normal, suggestive of inactive or silent disease. Pituitary apoplexy causing spontaneous remission of acromegaly was diagnosed, and close follow-up was planned for the evolution of hypopituitarism. Conclusion: This case highlights a rare presentation of acromegaly in which an episode of symptomatic pituitary apoplexy revealed the diagnosis of pituitary adenoma and led to the cure of growth hormone hypersecretion.

Keywords: Acromegaly; apoplexy; headache; spontaneous remission.

Figure 1.

Clinical photographs show facial features of acromegaly in the patient in 2008 (left panel) and in 2019 (right panel).

Figure 2.

Clinical photographs at admission show dental malocclusion and increased interdental spaces (left panel) and enlarged hands (right panel).

Figure 3.

Clinical photograph at admission shows prognathism.

Figure 4.

Magnetic resonance imaging of sellar region. T1-weighted coronal (left panel) and sagittal (middle panel) and T2-weighted sagittal (right panel) images show macroadenoma (arrows) with stalk deviation toward the left side. The lesion is hyperintense on T1-weighted images and hypointense on the T2-weighted image, suggestive of hemorrhage within.