A Case of Pituitary Apoplexy and Cavernous Sinus Syndrome during Hemodialysis
Background. Pituitary apoplexy (PA) is a clinical syndrome of pituitary hemorrhage or infarction and can result in hypopituitarism as well as compression of adjacent brain structures. Visual loss occurs frequently, as a result of tumor expansion and compression of the optic chiasm and optic nerves....
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Hindawi Limited
2023-01-01
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| Series: | Case Reports in Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2023/3183088 |
| _version_ | 1797834818002616320 |
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| author | Yusra Jamal Yudi Camacho Simon Hanft Patrick Chiarolanzio Michael D. Goldberg Jamie A. Mullally |
| author_facet | Yusra Jamal Yudi Camacho Simon Hanft Patrick Chiarolanzio Michael D. Goldberg Jamie A. Mullally |
| author_sort | Yusra Jamal |
| collection | DOAJ |
| description | Background. Pituitary apoplexy (PA) is a clinical syndrome of pituitary hemorrhage or infarction and can result in hypopituitarism as well as compression of adjacent brain structures. Visual loss occurs frequently, as a result of tumor expansion and compression of the optic chiasm and optic nerves. Additionally, with pituitary tumor invasion into the fixed space of the cavernous sinus, compression of multiple cranial nerves can result in cavernous sinus syndrome (CSS). We describe a case of an undiagnosed pituitary tumor manifesting as abrupt PA with CSS during hemodialysis (HD). Clinical Case. A 77-year-old male with end-stage renal disease (ESRD) presented with acute onset of severe headache, decreased vision, ophthalmoplegia of the left eye, and hypotension during HD. MRI of the brain revealed a 2.5 cm pituitary adenoma with acute hemorrhage, compression of the left prechiasmatic optic nerve, and invasion into the left cavernous sinus (CS). The hormonal profile was consistent with multiple pituitary hormone deficiencies. The patient was treated with glucocorticoids and underwent transsphenoidal resection of the tumor. He had an uneventful postoperative hospital course, and his left visual acuity stabilized, although there was no immediate improvement in his other ocular symptoms. Conclusion. Our case highlights a rare constellation of a pituitary adenoma with CS invasion complicated by PA and CSS during HD. The pathophysiology of PA is not well understood, and there are very limited data regarding PA in patients with end-stage renal disease (ESRD) on HD. Prompt recognition of PA in a patient presenting with CSS, particularly in the HD setting, is essential to ensure appropriate care is provided for this medical emergency. |
| first_indexed | 2024-04-09T14:43:33Z |
| format | Article |
| id | doaj.art-7b9c537a045f4a039c12855429de2378 |
| institution | Directory Open Access Journal |
| issn | 2090-651X |
| language | English |
| last_indexed | 2024-04-09T14:43:33Z |
| publishDate | 2023-01-01 |
| publisher | Hindawi Limited |
| record_format | Article |
| series | Case Reports in Endocrinology |
| spelling | doaj.art-7b9c537a045f4a039c12855429de23782023-05-03T00:00:14ZengHindawi LimitedCase Reports in Endocrinology2090-651X2023-01-01202310.1155/2023/3183088A Case of Pituitary Apoplexy and Cavernous Sinus Syndrome during HemodialysisYusra Jamal0Yudi Camacho1Simon Hanft2Patrick Chiarolanzio3Michael D. Goldberg4Jamie A. Mullally5Division of EndocrinologyDivision of EndocrinologyDepartment of Neurosurgical OncologyDepartment of RadiologyDivision of EndocrinologyDivision of EndocrinologyBackground. Pituitary apoplexy (PA) is a clinical syndrome of pituitary hemorrhage or infarction and can result in hypopituitarism as well as compression of adjacent brain structures. Visual loss occurs frequently, as a result of tumor expansion and compression of the optic chiasm and optic nerves. Additionally, with pituitary tumor invasion into the fixed space of the cavernous sinus, compression of multiple cranial nerves can result in cavernous sinus syndrome (CSS). We describe a case of an undiagnosed pituitary tumor manifesting as abrupt PA with CSS during hemodialysis (HD). Clinical Case. A 77-year-old male with end-stage renal disease (ESRD) presented with acute onset of severe headache, decreased vision, ophthalmoplegia of the left eye, and hypotension during HD. MRI of the brain revealed a 2.5 cm pituitary adenoma with acute hemorrhage, compression of the left prechiasmatic optic nerve, and invasion into the left cavernous sinus (CS). The hormonal profile was consistent with multiple pituitary hormone deficiencies. The patient was treated with glucocorticoids and underwent transsphenoidal resection of the tumor. He had an uneventful postoperative hospital course, and his left visual acuity stabilized, although there was no immediate improvement in his other ocular symptoms. Conclusion. Our case highlights a rare constellation of a pituitary adenoma with CS invasion complicated by PA and CSS during HD. The pathophysiology of PA is not well understood, and there are very limited data regarding PA in patients with end-stage renal disease (ESRD) on HD. Prompt recognition of PA in a patient presenting with CSS, particularly in the HD setting, is essential to ensure appropriate care is provided for this medical emergency.http://dx.doi.org/10.1155/2023/3183088 |
| spellingShingle | Yusra Jamal Yudi Camacho Simon Hanft Patrick Chiarolanzio Michael D. Goldberg Jamie A. Mullally A Case of Pituitary Apoplexy and Cavernous Sinus Syndrome during Hemodialysis Case Reports in Endocrinology |
| title | A Case of Pituitary Apoplexy and Cavernous Sinus Syndrome during Hemodialysis |
| title_full | A Case of Pituitary Apoplexy and Cavernous Sinus Syndrome during Hemodialysis |
| title_fullStr | A Case of Pituitary Apoplexy and Cavernous Sinus Syndrome during Hemodialysis |
| title_full_unstemmed | A Case of Pituitary Apoplexy and Cavernous Sinus Syndrome during Hemodialysis |
| title_short | A Case of Pituitary Apoplexy and Cavernous Sinus Syndrome during Hemodialysis |
| title_sort | case of pituitary apoplexy and cavernous sinus syndrome during hemodialysis |
| url | http://dx.doi.org/10.1155/2023/3183088 |
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