Prolactinoma with apoplexy in the context of thrombocytopaenia: A case report. (June 2022)

• Record Type: Journal Article
• Authors: Chow, Oliver; Pham, Therese; He, Brandon; Hort, Amy; Gibson, Damien; Olsson, Gemma
• Is Part Of: International journal of surgery case reports. Volume 95(2022)
• Publication Date: 2022-06
• Subjects: Prolactinoma -- Pituitary apoplexy -- Thrombocytopaenia -- Giant macroadenoma; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2022.107228
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction and importance: Pituitary apoplexy is a clinical syndrome that occurs secondary to abrupt haemorrhage or infarction and can cause a presentation with headache, visual disturbances, and various neurological deficits. Pituitary apoplexy is a rare clinical syndrome that is often misdiagnosed or discovered late in its clinical course due to its relatively nonspecific clinical presentation. Case presentation: The case describes patient with a giant prolactinoma which developed haemorrhagic progression in the context of previously undiagnosed coagulopathy from idiopathic thrombocytopaenia. Transcranial (rather than transnasal) surgery was performed for evacuation and debulking. Conclusion: The case highlights the management of an exceedingly large adenoma in the context of coagulopathy contributing to rapid clinical progression, as well as a positive clinical outcome in a patient with restored vision and pituitary function. Highlights: Apoplexy is a rare-sight threatening condition that must be considered in the context of undiagnosed endocrine deficiencies. A transcranial approach may be required over trans-nasal in the context of massive pituitary tumours. Early evacuation of haemorrhage allows for medical management of pituitary adenoma with good patient outcomes.