Abstract
Pituitary apoplexy (PA) is an endocrine emergency resulting from hemorrhage or infarction within a pituitary tumor or non-tumorous pituitary gland. The most important predisposing factors for PA are cerebral angiographic procedures, systemic hypertension, surgeries, head injury, coagulopathies, and drugs. Thrombocytopenia is a risk factor for PA. Dengue fever causes thrombocytopenia and there are reported cases of dengue hemorrhagic fever predisposing to PA. But there are no reported cases of dengue fever per se predisposing to PA, and we report such a case in an 85-year-old elderly male who presented with features suggestive of a hypertensive emergency and, on evaluation, was found to have a pituitary incidentaloma and dengue fever. During the hospital course, he developed acute IIIrd nerve palsy and, when evaluated, was found to have PA. He responded well to medical management with steroids and thyroxine. Prompt initiation of treatment is of utmost importance in pituitary apoplexy, as it can result in adverse events, including loss of vision and even death from hemodynamic compromise.
Highlights
Pituitary apoplexy (PA) is an acute clinical syndrome characterized by sudden-onset headache, vomiting, visual disturbances, altered sensorium, and ophthalmoplegia, secondary to hemorrhage or infarction within a pituitary tumor or non-tumorous pituitary gland [1]
A review of the literature showed five reported cases of dengue hemorrhagic fever predisposing to PA [1,2,3,4,5]
We report a case of pituitary apoplexy in an elderly male from dengue fever-induced thrombocytopenia
Summary
Pituitary apoplexy (PA) is an acute clinical syndrome characterized by sudden-onset headache, vomiting, visual disturbances, altered sensorium, and ophthalmoplegia, secondary to hemorrhage or infarction within a pituitary tumor or non-tumorous pituitary gland [1]. His CT brain showed a sellar lesion favoring a pituitary macroadenoma (25 x 24 mm) (Figure 1) In view of his fever and thrombocytopenia, he was evaluated for dengue fever and was found to have dengue immunoglobulin M (IgM) positive, and his platelet count was monitored daily (Table 2). A neurological examination revealed the presence of ptosis and a divergent squint in the right eye; pupils were mid-dilated and sluggish in reaction, the left eye was normal, and there were no signs of meningeal irritation In view of his incidentaloma, serum prolactin assay (Table 3) and a magnetic resonance imaging (MRI) plus MR angiogram of the brain was done, which revealed a pituitary macroadenoma with normal MR angiogram findings (Figures 2-3). A follow-up visit at two weeks showed a significant improvement of ptosis and full recovery in two months
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