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Pituitary apoplexy and associated cranial nerve palsies secondary to bleeding caused by immune thrombocytopaenia in a patient with known pituitary macroadenoma
  1. Christopher Ambrose1,
  2. Sruthi Sarma1,
  3. Ritwick Banerjee2 and
  4. Sam Myers1
  1. 1Department of Medicine for the Elderly, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
  2. 2Department of Diabetes and Endocrinology, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
  1. Correspondence to Dr Christopher Ambrose; chris.ambrose{at}gmail.com

Abstract

An 84-year-old man presented with a frontal headache and easy bruising. He had a background history of a pituitary macroadenoma, diagnosed incidentally a year earlier. Investigations showed haemorrhage into the pituitary macroadenoma leading to a diagnosis of pituitary apoplexy in the context of low platelet count secondary to immune thrombocytopaenia. He was treated with intravenous hydrocortisone, platelet transfusion, intravenous immunoglobulin and high-dose steroid. Neurosurgical intervention was not indicated initially. Five days into his admission, he developed bilateral ptosis and ophthalmoplegia. MRI confirmed further haemorrhage associated with compression of the optic chiasm. He was transferred to a tertiary neurosurgical centre where he underwent urgent surgical decompression. To date, there has been minor improvement in his neurological symptoms. Management of this patient required considerable multidisciplinary teamwork between the clinics of endocrinology, haematology, neurosurgery, ophthalmology and geriatrics.

  • haematology (incl blood transfusion)
  • pituitary disorders

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Footnotes

  • Contributors CA: responsible for overseeing the writing of the case report, writing the summary, background, differential diagnosis, outcome and follow-up and discussion as well as appraising the current literature relevant to the report. SS: wrote case presentation, investigation and treatment sections. She also collected consent from the patient and interviewed the patient post discharge to gain the patient's perspective. SM: collected the investigations and was responsible for opthalmological aspects of patient presentation and discussion. RB: responsible for overseeing the conception of the report as well as critical appraisal of the piece and expertise around the management of the patient. After first draft was completed, all authors were responsible for critical appraisal of the draft, evaluation of the intellectual content and gave final approval of the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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