title: Management dilemmas in a rare case of pituitary apoplexy in the setting of dengue hemorrhagic fever.
abstract: BACKGROUND
  Pituitary apoplexy occurs due to infarction or hemorrhage, within a pituitary adenoma or a nontumorous pituitary gland and can have catastrophic consequences. Dengue hemorrhagic fever (DHF) is a severe manifestation of the spectrum of dengue virus infection and is characterized by high-grade fever, thrombocytopenia, hemorrhagic tendencies, and increased vascular permeability. Cases of incidentalomas complicated by DHF and presenting with apoplexy are extremely rare.
  
  
  METHODS
  We describe the case of a 45-year-old gentleman who suffered an attack of pituitary apoplexy while being treated for DHF. The issues pertaining to the management of hydrocephalus, timing of surgical intervention, and treatment of electrolyte imbalances encountered in the dual setting of DHF and pituitary apoplexy are discussed with reference to the outcome in our case.
  
  
  CONCLUSIONS
  Although patients suffering from DHF harbor multiple factors, which may be precipitants of pituitary apoplexy, the association between these two conditions is rare and only few case reports document their coexistence. We review the pertinent literature and discuss the management dilemmas faced by us while dealing with these dual pathological states.
authors.affiliation: Department of Neurosurgery, NIMHANS, Bengaluru, Karnataka, India.
authors.forename: S J
authors.initials: SJ
authors.lastname: Balaparameswara Rao
authors.affiliation: Department of Neurosurgery, NIMHANS, Bengaluru, Karnataka, India.
authors.forename: Amey R
authors.initials: AR
authors.lastname: Savardekar
authors.affiliation: Department of Neuropathology, NIMHANS, Bengaluru, Karnataka, India.
authors.forename: B N
authors.initials: BN
authors.lastname: Nandeesh
authors.affiliation: Department of Neurosurgery, NIMHANS, Bengaluru, Karnataka, India.
authors.forename: A
authors.initials: A
authors.lastname: Arivazhagan
keywords: Dengue hemorrhagic fever; hydrocephalus; pituitary apoplexy; surgical management; thrombocytopenia