[Pituitary Apoplexy of a Gonadotropinoma and the Trh/gnrh Test]

Pituitary apoplexy is a rare but sometimes dramatic complication of pituitary tumors. We report the case of a 64-year-old man with a macroadenoma who complained of a sudden and intense headache after a dynamic TRH (200 mu g) and GnRH (100 mu g) test. Two days later, he presented an acute ophthalmoplegia with fever and deteriorating consciousness. Emergency CT scan showed contrast hypofixation compatible with necrosis of the adenoma, Surgical, tumoral decompression resolved quickly almost all symptoms. Immunohistochemical study of the tumor confirmed the diagnosis of gonadotropinoma. Several similar cases of pituitary apoplexy occurring after TRH or GnRH tests have been described the last ten years. As this test may sometimes confirm the diagnosis bf gonadotropinoma, it should be performed with caution in cases of clinically nan functioning pituitary macroadenoma.