MON-126 Pituitary Apoplexy As A Precipitating Factor For Diabetic Ketoacidosis

Abstract Disclosure: L. Hamann: None. C. Geary: None. V. Kantorovich: None. This case study details a 69 year old male presenting to the emergency department with complaints of headache, nausea, vomiting and shortness of breath in the setting of known type 2 diabetes. His initial work up was suggestive of diabetic ketoacidosis (DKA) for which he received insulin drip and intravenous fluid replacement. Endocrinology team was consulted and he was transitioned to basal bolus insulin and his DKA resolved, however, his headache persisted. His insulin requirements decreased each day with associated hypoglycemic events. On day four of hospitalization, the primary team planned to discharge patient home however there was a precipitous decline in renal function necessitating a longer inpatient stay. The primary team was concerned that the intravenous ketorolac being administered for persistent headache was worsening renal function and consulted the neurology team for input. Ultimately the following day an MRI of the brain was completed with showed a 2cm pituitary macroadenoma with findings concerning for apoplexy, later confirmed via histological sample. At that time full pituitary labs were obtained which showed low cortisol with inappropriately normal ACTH, low gonadotropins with low testosterone, low TSH with inappropriately low free T4; the remainder of pituitary labs including prolactin and IGF1 were unremarkable. Repeat cortisol the following morning was again low with corresponding hyponatremia and the patient was started on steroid replacement pending surgical plan. Ultimately, the patient underwent transphenoidal resection of a 2cm sellar lesion with invasion into the cavernous sinuses and bony erosion. Pathology was positive for gonadotrophin staining. The patient’s post-op course was unremarkable with no evidence of diabetes insipidus and he was discharged home on steroid and thyroid hormone replacement therapy. He reported significant relief in headache symptoms. He will follow-up in our neuroendocrine specialty clinic. Pituitary apoplexy is a rare, but life-threatening infarction or hemorrhage of the pituitary gland, often in the setting of a pre-existing pituitary adenoma1. DKA is a complication of diabetes, occurring secondary to insufficient insulin production, which results in hyperglycemia, ketosis and metabolic acidosis3. While DKA is a relatively common endocrine emergency, its occurrence secondary to pituitary apoplexy is exceptionally rare and poorly described. This patient’s presentation and hospital course highlights the potential of pituitary apoplexy as a precipitating factor for DKA. Presentation: Monday, July 14, 2025