Pituitary Apoplexy Secondary to Thrombocytopenia Due to Dengue Hemorrhagic Fever: A Case Report and Review of the Literature |
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| Affiliation: | 1. Department of Endocrinology, Tan Tock Seng Hospital;2. Department of Endocrinology Changi General Hospital;3. Department of Pathology, Tan Tock Seng Hospital;4. Yong Loo Lin School of Medicine, DUKE-NUS Graduate Medical School, National University Singapore;1. Department of Endocrinology;2. Department of Gynecology;3. Department of Pathology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon.;1. Interdisziplinäre Endokrinologie, Diabetologie und Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf,;2. Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf;3. Klinik und Poliklinik für Nuklearmedizin, Zentrum für Radiologie und Endoskopie, Hamburg, Germany.;1. Department of Endocrinology, University Hospital Complex, Albacete, Spain;2. Departments of Endocrinology and Molecular Genetics,;3. Clinical Genetics, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, United Kingdom.;1. The Hilda and J. Lester Gabrilove Division of Endocrinology, Diabetes, and Bone Disease, Department of Medicine, The Mount Sinai Hospital, New York, New York;2. Department of Urology, The Mount Sinai Hospital, New York, New York. |
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| Abstract: | Objective:To present a case of pituitary apoplexy secondary to thrombocytopenia associated with dengue hemorrhagic fever (DHF).Methods:In this case study, we review the presentation, evaluation, diagnosis, and management of a case of pituitary apoplexy in the setting of DHF. We also searched the literature for cases of pituitary apoplexy associated with thrombocytopenia and review their clinical presentation, management, and outcome.Results:A 53-year-old man presented with fever, lethargy, and worsening headache. Routine investigations revealed thrombocytopenia secondary to dengue fever. He developed symptoms of a cavernous sinus lesion the next day. Urgent magnetic resonance imaging revealed pituitary apoplexy in a pituitary macroadenoma. A transsphenoidal surgery was done and histology was consistent with apoplexy in a prolactin/follicle-stimulating hormone macroadenoma. Subsequently, the patient developed permanent deficits of anterior pituitary hormones. We review 8 other cases of pituitary apoplexy associated with thrombocyto-penia reported in the literature.Conclusion:Thrombocytopenia due to various causes may be a predisposing factor for pituitary apoplexy in a patient with underlying pituitary disease. In view of the tendency for bleeding associated with thrombocytopenia, the risks of surgical intervention have to be carefully weighed against the potential benefits. Indications for surgery would include progressive alteration of consciousness, visual disturbances, and opthalmoplegia despite conservative management. Patients with underlying pituitary macroadenomas with optic chiasm compression have a worse prognosis, and the chances of recovery, even with early surgery, are limited. |
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