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Case Reports: Reminder of important clinical lesson
Pituitary apoplexy and cerebral infarction
  1. Rute Brás-Cruz1,
  2. Isabel Cruz2 and
  3. Sara Camões1
  1. 1Department of Medicine - Internal Medicine, Hospital Pedro Hispano, Matosinhos, Portugal
  2. 2Internal Medicine, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
  1. Correspondence to Dr Rute Brás-Cruz; rutebcruz{at}gmail.com

Abstract

Pituitary apoplexy (PA) is a possible complication of pituitary adenoma but is rarely followed by cerebral infarction. The mechanism by which this occurs is not totally understood but is believed to have multiple aetiologies such as arterial compression due to mass effect, vasospasm induced by the presence of blood or by vasoactive agents. In this report, we present a man in his 80s with known pituitary adenoma with a sudden onset of left central facial palsy, left hemiparesis, paresis of the VI left pair and previously unrecognised atrial fibrillation in the ECG. At first, the signs of haemorrhage on imaging were unnoticed, which led to a diagnosis of ischaemic stroke that was submitted to thrombolysis. Due to complications during hospitalisation, the team suspected of PA with panhypopituitarism, confirmed by brain MRI and blood tests. The patient underwent conservative management with glucocorticoids with resolution of the acute adrenal insufficiency related symptoms.

  • Pituitary disorders
  • Neuroimaging
  • Stroke

http://dx.doi.org/10.1136/bcr-2022-254507

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    Footnotes

    • Contributors Each author has made a significant contribution to the final draft of this manuscript. RB-C: involved in conception and design, acquisition of data, analysis and interpretation of data. Drafted the article. Final approval of the version published. Agreement to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved. IC: involved in conception and design, and acquisition of data. Drafted the article. Final approval of the version published. Agreement to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved. SJSC: involved in conception and design, acquisition of data, analysis and interpretation of data. Revised the article critically for important intellectual content. Final approval of the version published. Agreement to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

    • 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

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