SAT-078 Remission of Acromegaly Following Pituitary Apoplexy

Abstract Disclosure: C.K. Park: None. Y. Alhalalmeh: None. M. Rayan: None. L. Ghalib: None. Background: Acromegaly is characterized by excessive GH and IGF-1 secretion, typically caused by a pituitary adenoma. Pituitary apoplexy is an acute infarction of the pituitary gland and often occurs in the context of a pre-existing pituitary adenoma. There have been few cases documented of acromegaly complicated by pituitary apoplexy, followed by spontaneous biochemical remission of the acromegaly (1). Clinical Case: A 33-year-old male with history of polysubstance use was admitted with altered mental status and hypoxia after being found down. He was found to have an elevated carboxyhemoglobin level, concerning for carbon monoxide poisoning. MRI brain was obtained as part of an encephalopathy workup and revealed a large (2.7 x 2.1 cm) non-enhancing lesion in the sella, suggestive of a macroadenoma, with a small amount of T1 hyperintensity at the superior aspect of the lesion. The patient exhibited coarse facial features and endorsed a 1-year history of enlarging hands and feet, decreased sexual function, and new headaches. Baseline laboratory findings, including elevated IGF-1 (914 ng/mL) and GH (3.29 ng/mL), were consistent with acromegaly. During his hospitalization, he developed rapid pan-hypopituitarism with multiple axes (i.e., pituitary-adrenal, pituitary-thyroid, and pituitary-gonadal) damaged. IGF-1 spontaneously dropped to 177.1 ng/mL and GH normalized to 0.32 ng/mL within 4 days. He was started on hydrocortisone at discharge. Due to the presence of optic chiasm compression on MRI, he ultimately underwent a sublabial approach surgical adenoma resection. Pathology of the pituitary gland lesion showed necrotic tissue, confirming pituitary apoplexy. Conclusion: Herein we describe a case of pituitary GH adenoma apoplexy that led to endocrinological cure of acromegaly. While spontaneous remission can occur, as in this case, it requires ongoing monitoring of GH and IGF-1 levels. In addition, for patients with acromegaly and pituitary adenomas, the risk of apoplexy increases due to the high vascularity of the adenoma. Our patient, however, may have exhibited additional unique risk factors for apoplexy, including hypoxia secondary to carbon monoxide poisoning and intranasal cocaine use. Understanding these less common risk factors for pituitary apoplexy can assist in prompt diagnosis and management. References: 1.Zheng XQ, Zhou X, Yao Y, Deng K, You H, Duan L, Zhu HJ. Acromegaly complicated with fulminant pituitary apoplexy: clinical characteristic analysis and review of literature. Endocrine. 2023 Jul;81(1):160-167. doi: 10.1007/s12020-023-03379-7. Epub 2023 May 17. PMID: 37195580; PMCID: PMC10189214. Presentation: Saturday, July 12, 2025