MON-115 Pituitary Apoplexy During Pregnancy, a Rare Endocrinology Emergency

Abstract Disclosure: M. Asadi: None. D.D. Bagar: None. H.P. Gnanapragasam: None. Introduction: Pituitary apoplexy is an emergency characterized by symptoms such as severeheadache, visual disturbances, and hemodynamic instability. One common risk factor forpituitary apoplexy is postpartum hemorrhage, which can lead to pituitary ischemia and apoplexy.Pituitary apoplexy during pregnancy is a rarer condition. It usually occurs due to an underlyingpituitary lesion. However, there has been a case report of pituitary apoplexy occurring withoutany identifiable underlying lesion.Diagnosing pituitary apoplexy can be challenging, especially since its common symptoms ofsevere headache and visual disturbances can also occur in conditions such as hypertensive crisesor pre-eclampsia.Case:A 31-year-old female, G2P1001, at 20 weeks and 3 days gestation was transferred from a localclinic to the emergency room following a brain MRI conducted for complaints of persistentheadaches for 9 days. The MRI revealed a cystic mass measuring 1.0 cm x 0.9 cm in the pituitarygland, containing blood products. During transportation to the hospital, she received 100 mg ofIV hydrocortisone.According to the patient, her headaches were constantly present, worsening onsome days and improving on others. The headaches were associated with light sensitivity andleft-sided facial numbness.Upon arrival, her serum electrolytes, including sodium and potassium, were within normal limits.Additionally, her free T4 was measured at 0.9 ng/dl (normal range: 0.8-1.8), and her TSH was0.45 µIU/ml (normal range: 0.27-4.2).The MRI was reviewed by the neurosurgery and neuro-ophthalmology services, whorecommended conservative management since the patient's headache improved and the opticchiasm was intact. She was discharged a few days later with a tapering dose of hydrocortisone,prescribed as 15 mg in the morning and 5 mg in the afternoon.A fasting early morning serum total cortisol level was rechecked a week later, and the resultswere normal. Afterward, hydrocortisone was discontinued. During her hospital stay, both free T4 and TSH levels remained within normal limits. Thesewere rechecked after 34 days and continued to be within normal limits. However, by day 55, herfree T4 level decreased to 0.73 ng/dl (normal range: 0.76-1.46 ng/dl) and her TSH level was 1.01µIU/ml (normal range: 0.36-3.74 µIU/ml). Due to concerns of central hypothyroidism,Levothyroxine 75 mcg daily was initiated.A follow-up brain MRI after 50 days indicated a stable right sellar lesion. As of the last follow-up, she is currently at 34 weeks’ gestation and her condition is stable. Conclusions: Early recognition and multidisciplinary management are crucial in optimizingoutcomes for pituitary apoplexy during pregnancy. This case underscores the need for heightenedawareness and prompt intervention, close follow-up after acute inpatient management andreplacing hormones as needed. Presentation: Monday, July 14, 2025