Hemorrhagic pituitary apoplexy in an 18 year-old male presenting as non-ketotic hyperglycemic coma (NKHC).
Pituitary apoplexy is an acute clinical event usually caused by hemorrhage or infarction in a pituitary adenoma. We report the unusual case of hemorrhagic pituitary apoplexy in an 18 year-old male with previously undiagnosed type 2 diabetes mellitus who presented with unexplained hyperglycemia (glucose 49.2 mmol/l [887 mg/dl]) and obtundation and in whom an initial diagnosis of non-ketotic hyperglycemic coma (NKHC) was made. MRI revealed a heterogeneous mass arising from an expanded sella turcica into the suprasellar cistern. Despite well-controlled glucose levels on continuous insulin infusion, dexamethasone, and initiation of bromoergocriptine (parlodel) therapy, the patient's vision and pupillary responses deteriorated acutely. Following emergency transphenoidal surgery, the patient's vision and mental status improved. Data confirmed preoperative panhypopituitarism; serum prolactin was 396 ng/ml (microg/l). Immunostudies demonstrated tumoral labeling for prolactin, but not for ACTH, GH, TSH, LH, FSH, or P53.
Kamboj
Manmohan K
MK
Department of Pediatrics, Division of Pediatric Endocrinology, New York University School of Medicine, New York, USA.
Zhou
Ping
P
Molofsky
Walter J
WJ
Franklin
Bonita
B
Shah
Bina
B
David
Raphael
R
Kohn
Brenda
B
D000236:Adenoma / Q000473:pathology; D000293:Adolescent; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D010899:Pituitary Apoplexy / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D010902:Pituitary Gland / Q000473:pathology; D010907:Pituitary Hormones / Q000097:blood; D010911:Pituitary Neoplasms / Q000473:pathology; D012658:Sella Turcica / Q000473:pathology
D010907:Pituitary Hormones