Transient central diabetes insipidus followed by pituitary apoplexy treated in a conservative way

Abstract

A 49-year-old man, previously diagnosed with systemic ar-terial hypertension, presented to emergence room with severe headache. On physical examination blood pressure was 160x100 mm Hg. After 10 hours, despite of blood pressure normaliza-tion, the headache persisted and was followed by ophthalmo-plegia, meningeal irritation signs and consciousness impairment. A lumbar puncture was performed and meningitis was exclud-ed. Brain computed tomography was done and only maxillary sinusitis was detected. Three days after, the patient developed hypotension. Magnetic resonance imaging demonstrated a mac-roadenoma of 20x15x15 mm with supra-sellar extension and in-tratumoral hemorrhage (Figure). At that moment, pituitary func-tion tests were normal (thyrotropin: 1.46 mcUI/mL; RV: 0.3 a 5.0 mcUI/mL; free T4: 1.3 ng/dL; RV: 0.8-1.9 ng/dL; prolactin: 3.4 ng/dL; RV: 2,0 a 15,2 ng/mL) except for a low cortisol level (5.7