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Pituitary Apoplexy Secondary to Thrombocytopenia Due to Dengue Hemorrhagic Fever: A Case Report and Review of Literature.
MedLine Citation:
PMID:  24325998     Owner:  NLM     Status:  Publisher    
Objective : To present a case of pituitary apoplexy secondary to thrombocytopenia associated with dengue hemorrhagic fever (DHF).Methods : In this case study we review the presentation, evaluation, diagnosis and management of a case of pituitary apoplexy in the setting of DHF. We also searched the literature for cases of pituitary apoplexy associated with thrombocytopenia and we reviewed their clinical presentation, management and outcome.Results : This 53 years old gentleman presented with fever, lethargy and worsening headache. Routine investigations revealed thrombocytopenia secondary to Dengue fever. He developed symptoms of a cavernous sinus lesion the next day. An urgent MRI revealed pituitary apoplexy in a pituitary macroadenoma. A trans-sphenoidal surgery was done and histology was consistent with apoplexy in a prolactin/FSH macroadenoma. He developed permanent deficits of anterior pituitary hormones subsequently. We review 8 other cases of pituitary apoplexy associated with thrombocytopenia reported in the literature.Conclusion : Thrombocytopenia due to various causes may be a predisposing factor resulting in pituitary apoplexy in a patient with underlying pituitary disease. In view of the bleeding tendency associated with thrombocytopenia the risks of surgical intervention has to be carefully weighed against benefits. Indications for surgery would include progressive alteration of consciousness, visual disturbances and opthalmoplegia despite conservative management. Patients with underlying pituitary macroadenomas with optic chiasm compression have a worse prognosis and the chances of recovery even with early surgery is limited.
Seng Kiong Tan; Cherng Jye Seow; Eberta Tan; Yuk Ping Chau; Rinkoo Dalan
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-12-10
Journal Detail:
Title:  Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists     Volume:  -     ISSN:  1934-2403     ISO Abbreviation:  Endocr Pract     Publication Date:  2013 Dec 
Date Detail:
Created Date:  2013-12-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9607439     Medline TA:  Endocr Pract     Country:  -    
Other Details:
Languages:  ENG     Pagination:  1-19     Citation Subset:  -    
Department of Endocrinology, Tan Tock Seng Hospital.
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