Pituitary Adenoma Apoplexy in an Adolescent: A Case Report and Review of the Literature

Transnasal Transsphenoidal Approach for a Nine-Year-Old Child With Pituitary Apoplexy: A Case Report

Pituitary apoplexy is a rare but potentially life-threatening condition of sudden hemorrhage or infarction within the pituitary gland that results in symptoms of acute onset such as severe headache, visual impairment, and hormonal deficiencies. Though more common in adults, the same criteria for diagnostic and management dilemmas apply to pediatric cases. We present the case of a nine-year-old boy presenting with acute-onset severe headache and significant visual deterioration suggestive of pituitary apoplexy. An emergency MRI was performed, which showed a hemorrhagic sellar and suprasellar mass compressing the optic chiasm. Given the severe visual symptoms in this case, emergency surgical intervention was indicated. Decompression and gross total resection of the tumor were successfully attained using the endoscopic transnasal transsphenoidal approach by a multidisciplinary team. After the surgery, there was a significant improvement in the visual field, especially regarding the right eye's nasal hemifield, and the motor strength and consciousness remained stable. This case underscores the importance of early diagnosis and expedited surgical management in pediatric pituitary apoplexy. The transnasal transsphenoidal approach is practical for maximal decompression of the optic apparatus and reduces the risk of long-term visual deficits. In addition, it points out the need for coordinated, multidisciplinary treatment with the participation of neurosurgeons, endocrinologists, and pediatricians both for immediate and long-term consequences, including potential hormonal deficiencies. The report emphasizes the need for vigilance and prompt intervention in pediatric presentations, unlike the index case, for better outcomes and to avoid permanent morbidity.

Effect of hydrocortisone on hypocorticolism caused by pituitary adenoma

OBJECTIVES

Pituitary adenoma is a tumor that can cause hormonal secretion problems, including hypocortisolism. Hypocortisolism may result in negative impacts such as an increase in proinflammatory cytokine and immune system activation. Hypocortisolism therapy is performed by giving high-dose hydrocortisone. This case report presented a hypocortisolism therapy using hydrocortisone in a patient with pituitary adenoma.

CASE PRESENTATION

A 17-year-old boy was admitted to a hospital due to right-eye vision loss, headache, and swallowing difficulty. During the treatment at the hospital, the patient had light depression. The brain Magnetic Resonance Imaging (MRI) scanning with contrast showed there was a supratentorial axial lesion enlarged from the intrasellar to the suprasellar. The anamnesis and physical examination, as well as laboratory and supporting examinations, showed that the patient was diagnosed to suffer from pituitary macroadenoma. The laboratory examination showed that the size of hypocortisolism was at <0.5 μg/dL (reference value ranges from 4.30-22.40 μg/dL). The patient was treated with hydrocortisone IV therapy at 100 mg/dose administered in the morning and evening for 4 days. Then, the dose tapering off of 100 mg/dose was administered in the morning for 4 days. After that, the patient received hydrocortisone of 20 mg/dose peroral administration in the morning and evening until the patient was discharged from the hospital. Tapering off was performed to prevent the side effects of high-dose hydrocortisone. Besides, the patient was alsounder the Endoscopic Endonasal Transsphenoidal Hypophysectomy (EETH). The cortisol level in the pretreatment was at <0.5 and 5.3 μg/dL during the treatment. There were no side effects of the treatment when the patients were hospitalized.

CONCLUSIONS

The hydrocortisone IV therapy with 100 mg/do was administered in the morning and evening for 4 days, and then the dose tapering off of 100 mg/dose was done in the morning for 4 days. Then, the hydrocortisone therapy of 20 mg/dose peroral administration to the patient with pituitary macroadenoma in the morning and evening to improve the cortisol level. The cortisol level in the pretreatment was at 0.5 and 5.3 μg/dL in the post-treatment.