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Post-Traumatic Pituitary Tumor Apoplexy After Closed Head Injury: Case Report and Review of the Literature.
World Neurosurg. 2018 Dec; 120:331-335.WN

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.

Authors+Show Affiliations

Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.Department of Pathology and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.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.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.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30213676

Citation

Ward, Max, et al. "Post-Traumatic Pituitary Tumor Apoplexy After Closed Head Injury: Case Report and Review of the Literature." World Neurosurgery, vol. 120, 2018, pp. 331-335.
Ward M, Kamal N, Majmundar N, et al. Post-Traumatic Pituitary Tumor Apoplexy After Closed Head Injury: Case Report and Review of the Literature. World Neurosurg. 2018;120:331-335.
Ward, M., Kamal, N., Majmundar, N., Baisre-De Leon, A., Eloy, J. A., & Liu, J. K. (2018). Post-Traumatic Pituitary Tumor Apoplexy After Closed Head Injury: Case Report and Review of the Literature. World Neurosurgery, 120, 331-335. https://doi.org/10.1016/j.wneu.2018.08.238
Ward M, et al. Post-Traumatic Pituitary Tumor Apoplexy After Closed Head Injury: Case Report and Review of the Literature. World Neurosurg. 2018;120:331-335. PubMed PMID: 30213676.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Post-Traumatic Pituitary Tumor Apoplexy After Closed Head Injury: Case Report and Review of the Literature. AU - Ward,Max, AU - Kamal,Naveed, AU - Majmundar,Neil, AU - Baisre-De Leon,Ada, AU - Eloy,Jean Anderson, AU - Liu,James K, Y1 - 2018/09/10/ PY - 2018/07/19/received PY - 2018/08/28/revised PY - 2018/08/30/accepted PY - 2018/9/15/pubmed PY - 2018/12/15/medline PY - 2018/9/15/entrez KW - Endoscopic endonasal approach KW - Pituitary apoplexy KW - Traumatic SP - 331 EP - 335 JF - World neurosurgery JO - World Neurosurg VL - 120 N2 - 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. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/30213676/Post_Traumatic_Pituitary_Tumor_Apoplexy_After_Closed_Head_Injury:_Case_Report_and_Review_of_the_Literature_ DB - PRIME DP - Unbound Medicine ER -