Post-Traumatic Pituitary Tumor Apoplexy After Closed Head Injury: Case Report and Review of the Literature

Authors

Max Ward, Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.
Naveed Kamal, Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.
Neil Majmundar, Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.
Ada Baisre-De Leon, Department of Pathology and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.
Jean Anderson Eloy, Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA; Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA; Department of Ophthalmology and Visual Sciences, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.
James K. Liu, Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA; Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA. Electronic address: james.liu.md@rutgers.edu.

Document Type

Article

Abstract

BACKGROUND: Head trauma is a rare inciting factor of pituitary apoplexy (PA); however, there is a clear temporal relationship between trauma and apoplexy, and this is the first reported case of PA after an assault. CASE DESCRIPTION: We present a rare case of a 63-year-old man who developed PA after sustaining a closed head injury from assault with a metal pole. The patient had a known pituitary tumor for which he had previously declined surgical resection. On initial computed tomography scan, there was no traumatic intracerebral hemorrhage or subarachnoid hemorrhage. There was sellar expansion but no obvious sellar hemorrhage. Within 48 hours of admission, the patient was presumed septic after developing altered mental status, fevers, hypotension, and tachycardia. Magnetic resonance imaging of the brain with and without gadolinium revealed a poorly enhancing, necrotic, and hemorrhagic pituitary mass, consistent with pituitary tumor apoplexy. After administration of intravenous glucocorticoids, the patient underwent emergent endoscopic transsphenoidal resection of the pituitary tumor apoplexy. Postoperatively, the patient had neurologic improvement with stable vision. CONCLUSIONS: Early and accurate diagnosis is important to allow for timely neurosurgical intervention. Symptoms of fever, hypotension, and tachycardia in a patient with a known sellar mass should raise the suspicion of hypocortisolemia from pituitary tumor apoplexy.

Medical Subject Headings

Adenoma (diagnostic imaging, pathology, surgery); Diagnosis, Differential; Emergencies; Endoscopy; Glucocorticoids; Head Injuries, Closed (complications, diagnostic imaging, surgery); Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pituitary Apoplexy (diagnostic imaging, pathology, surgery); Pituitary Neoplasms (diagnostic imaging, pathology, surgery); Sphenoid Sinus (diagnostic imaging, surgery); Tomography, X-Ray Computed

Publication Date

12-1-2018

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

120

First Page

331

Last Page

335

PubMed ID

30213676

Digital Object Identifier (DOI)

10.1016/j.wneu.2018.08.238

Recommended Citation

Ward, Max; Kamal, Naveed; Majmundar, Neil; Baisre-De Leon, Ada; Eloy, Jean Anderson; and Liu, James K., "Post-Traumatic Pituitary Tumor Apoplexy After Closed Head Injury: Case Report and Review of the Literature" (2018). Neurosurgery. 2221.
https://scholar.barrowneuro.org/neurosurgery/2221