Pituitary apoplexy: Case report with review of literature

ABSTRACT

A fifty five year old gentleman was admitted with uncontrolled hypertension. Within 24 hours, he became drowsy and later on started complaining of visual deterioration. Neuro-imaging identified pituitary tumor with bleed. He was treated for pituitary apoplexy. He underwent emergency trans-sphenoid decompression of pituitary tumor. He had a very turbulent post operative course and required aggressive management of Diabetes Insipidus with up to 10 liters of IV fluids infusion per day which was later controlled with desmopressin puffs. He was discharged once the condition was brought under control but returned ten days later with upper GI bleeding. He had been on replacement steroids all this time with proton pump inhibitors. He was found to have two superficial non bleeding ulcers in first part of duodenum. He was managed with blood transfusion and high dosage of proton pump inhibitors. Vision gradually improved and has reached almost normal. He has remained symptom free now and being treated medically for his pan-hypopituitarism. Management of pituitary apoplexy is discussed in the light of available literature