An Unexpected Headache: Pituitary Apoplexy in a Patient Admitted with Diabetes Ketoacidosis (DKA)
International Neuropsychiatric Disease Journal,
Page 13-21
DOI:
10.9734/indj/2022/v18i4358
Abstract
Background: Pituitary apoplexy is a clinical problem resulting from abrupt pituitary ischemia or hemorrhage. A small proportion of pituitary adenomas manifest as an apoplectic crisis, with pan hypopituitarism, vomiting, nausea, headache, ophthalmoplegia, and visual impairment being the most common symptoms.
Case Report: A 32-year-old diabetic Asian male presented to the emergency department with symptoms of polyuria, polydipsia, persistent vomiting, and diffused abdominal pain. He also reported a recent fever and severe headache, as well as self-limited episodes of blurring of vision and diplopia three months prior. Upon admission, his vitals were stable and he was fully conscious and oriented, though irritable and anxious. On examination, he was found to have third cranial nerve palsy and a dilated pupil with no light reflex. Laboratory tests revealed diabetic ketoacidosis (DKA). A CT scan of the brain revealed a possible invasive pituitary macro adenoma and the patient was referred for further evaluation. He also tested positive for COVID-19. Treatment for DKA was initiated and an MRI scan was scheduled for further evaluation. However, the patient's condition worsened and he was transferred to the ICU, where he was intubated and an MRI indicated a hemorrhagic mass in the pituitary gland. The patient was diagnosed with pituitary apoplexy, and he also received treatment with antibiotics and antiviral medication for suspected encephalitis.
Conclusion: Pituitary apoplexy is a serious condition that requires immediate evaluation and treatment. It can cause permanent damage or death if left untreated. Treatment options include surgery and conservative management with frequent monitoring.
Keywords:
- Pituitary apoplexy
- adenomas
- diabetic ketoacidosis
- third nerve palsy
- encephalitis
How to Cite
References
Pyrgelis ES, Mavridis I, Meliou M. Presenting symptoms of pituitary apoplexy. 2018;79(01):052-9.
Barkhoudarian G, Kelly DF. Pituitary apoplexy. 2019;30(4):457-63.
Suri H, Dougherty C. Reports H. Presentation and management of headache in pituitary apoplexy. 2019; 23(9):1-4.
Singh TD, Valizadeh N, Meyer FB, Atkinson JL, Erickson D, Rabinstein AA. Management and outcomes of pituitary apoplexy. 2015;122(6):1450-7.
Shepard MJ, Snyder MH, Soldozy S, Ampie LL, Morales-Valero SF, Jane JA. Radiological and clinical outcomes of pituitary apoplexy: comparison of conservative management versus early surgical intervention. 2021;135(5):1310- 8.
Cavalli A, Martin, A, Connolly DJ, Mirza S, Sinha SJB. Pituitary apoplexy: how to define safe boundaries of conservative management? Early and long-term outcomes from a single UK tertiary neurosurgical unit. 2021;35(3):334- 40.
Taweesomboonyat C, Oearsakul TJWN. Factors Predicting neuroendocrine recovery following transsphenoidal surgery in pituitary apoplexy patients. 2022; 159:e40-e7.
Galal A, Ahmed OEF. Determinants of visual and endocrinological outcome after early endoscopic endonasal surgery for pituitary apoplexy. Surg Neurol Int. 2022;13:433.
Published 2022 Sep 23.
DOI:10.25259/SNI_642_2022.
Pelkonen R, Kuusisto A, Salmi J, Eistola P, Raitta C, Karonen SL, et al. Pituitary function after pituitary apoplexy. 1978;65(5):773-8.
Gruber A, Clayton J, Kumar S, Robertson I, Howlett T, Mansell P. Pituitary apoplexy: retrospective review of 30 patients—is surgical intervention always necessary? 2006;20(6):379-85.
Kim YH, Cho YH, Hong SH, Kim JH, Kim MS, Khang SK, et al. Postoperative neurologic outcome in patients with pituitary apoplexy after transsphenoidal surgery. 2018;111:e18-e23.
Goshtasbi K, Abiri A, Sahyouni R, et al. Visual and endocrine recovery following conservative and surgical treatment of pituitary apoplexy: A meta-analysis. World Neurosurg. 2019;132:33-40.
DOI:10.1016/j.wneu.2019.08.115
Donegan D, Erickson D. Revisiting pituitary apoplexy. J Endocr Soc. 2022;6(9): bvac113. Published 2022 Jul 26.
DOI:10.1210/jendso/bvac113
Almeida JP, Sanchez MM, Karekezi C, Warsi N, Fernández-Gajardo R, Panwar J, et al. Pituitary apoplexy: results of surgical and conservative management clinical series and review of the literature. 2019;130:e988-e99.
Garni Barkhoudarian, Daniel F. Kelly. Pituitary apoplexy, neurosurgery clinics of North America. 2019;30(4):457-463.
ISSN 1042-3680, ISBN 9780323681681,
DOI:https://doi.org/10.1016/j.nec.2019.06.001.
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