title: Pituitary apoplexy secondary to thrombocytopenia due to dengue hemorrhagic fever: a case report and review of the literature.
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 thrombocytopenia reported in the literature.
  
  
  CONCLUSIONS
  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.
authors: Department of Endocrinology, Tan Tock Seng Hospital.
authors: Seng Kiong
authors: SK
authors: Tan
authors: Department of Endocrinology, Tan Tock Seng Hospital.
authors: Cherng Jye
authors: CJ
authors: Seow
authors: Department of Endocrinology Changi General Hospital, Tan Tock Seng Hospital.
authors: Eberta
authors: E
authors: Tan
authors: Department of Pathology, Tan Tock Seng Hospital.
authors: Yuk Ping
authors: YP
authors: Chau
authors: Yong Loo Lin School of Medicine, DUKE-NUS Graduate Medical School, National University Singapore.
authors: Rinkoo
authors: R
authors: Dalan