Cocaine-Induced Pituitary Apoplexy and Panhypopituitarism

Objective: Chronic cocaine use has been implicated in panhypopituitarism. Acute cocaine intoxication resulting in pituitary apoplexy and panhypopituitarism has not been reported in the literature. Methods: We hereby report a case of panhypopituitarism resulting from pituitary apoplexy induced by a single intranasal cocaine use. Results: A 54-year-old African American man presented with a week-long headache that started 2 hours after snorting a gram of cocaine. His physical exam was normal. His labs were suggestive of panhypopituitarism. Anti-neutrophil cytoplasmic antibodies were negative. Brain magnetic resonance imaging with and without contrast showed a large complex sellar mass with hemorrhagic and necrotic components. Surgical decompression was deferred due to normal visual acuity and absence of visual field defects. He received a stress dose of glucocorticoids followed by maintenance dose and was discharged on the glucocorticoid with levothyroxine replacement. The patient has been lost to follow-up. Conclusion: Although the association of cocaine use with myocardial infarction and stroke has been well described, pituitary apoplexy and panhypopituitarism resulting most likely from severe vasoconstriction of hypophyseal vessels need special mention. We suggest that the diagnosis of cocaine-induced pituitary apoplexy should be considered in subjects presenting with severe headaches after cocaine inhalation.