Download PDF
CC BY-NC-ND 4.0 · J Neurol Surg Rep 2023; 84(02): e61-e64
DOI: 10.1055/a-2072-0147
Original Article

Immune Thrombocytopenic Purpura Presenting with Pituitary Apoplexy: A Case Report and Literature Review

Omar Nabulsi 
1   Department of Neurosurgery, Spectrum Health, Grand Rapids, Michigan, United States
,
Mohamed Abouelleil
1   Department of Neurosurgery, Spectrum Health, Grand Rapids, Michigan, United States
,
Leah Lyons
1   Department of Neurosurgery, Spectrum Health, Grand Rapids, Michigan, United States
,
Meggen Walsh
1   Department of Neurosurgery, Spectrum Health, Grand Rapids, Michigan, United States
,
Justin Singer
1   Department of Neurosurgery, Spectrum Health, Grand Rapids, Michigan, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Pituitary apoplexy is a rare condition that usually occurs in the setting of a pituitary adenoma. It can present with symptoms of visual disturbances, vertigo, headache, and neurological impairments. Computed tomography (CT) scans can aid in identifying pituitary apoplexy and ruling out other diseases. We present a unique case of pituitary apoplexy in the setting of immune thrombocytopenic purpura (ITP).

Case Description A 61-year-old man with a past medical history significant for myocardial infarction presented to the emergency department with symptoms of diplopia and headache 36 hours after onset. The patient was found to have severe thrombocytopenia with a platelet count below 20,000. A CT of the head revealed a possible pituitary adenoma with compression of the optic chiasm. The patient's platelet count continued to decrease throughout his admission and dropped below 7,000 on day 2 of admission. The patient was given platelet transfusion along with intravenous immunoglobulins. The patient underwent endoscopic transsphenoidal resection of the pituitary mass. Pathology of the mass revealed immature platelets characteristic of immune ITP in the setting of pituitary apoplexy.

Conclusion While ITP in the setting of pituitary apoplexy is a rare entity, we believe that clinicians should have pituitary apoplexy on their differential diagnosis in patients with ITP.

Keywords

pituitary apoplexy - immune thrombocytopenic purpura - pituitary adenoma - pituitary mass resection


Publication History

Received: 01 March 2022

Accepted: 26 January 2023

Accepted Manuscript online:
12 April 2023

Article published online:
18 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Nass R, Evans WS. Physiologic and pathophysiologic alterations of the neuroendocrine components of the reproductive axis. In: Strauss JF, Barbieri RL, eds. Yen and Jaffe's Reproductive Endocrinology. 8th ed. Elsevier; 2019: 473-519
    Search in Google Scholar
  • 2 Vaphiades MS. Pituitary apoplexy. Medscape [Internet]. 2017 [cited September 24, 2018]. Accessed 01 May 2023 at: https://emedicine.medscape.com/article/1198279-overview (last updated 3 June 2022)
    PubMed
  • 3 Briet C, Salenave S, Bonneville J-F, Laws ER, Chanson P. Pituitary apoplexy. Endocr Rev 2015; 36 (06) 622-645
    CrossrefPubMedSearch in Google Scholar
  • 4 Goyal P, Utz M, Gupta N. et al. Clinical and imaging features of pituitary apoplexy and role of imaging in differentiation of clinical mimics. Quant Imaging Med Surg 2018; 8 (02) 219-231
    CrossrefPubMedSearch in Google Scholar
  • 5 Nawar RN, AbdelMannan D, Selman WR, Arafah BM. Pituitary tumor apoplexy: a review. J Intensive Care Med 2008; 23 (02) 75-90
    CrossrefPubMedSearch in Google Scholar
  • 6 Verrees M, Arafah BM, Selman WR. Pituitary tumor apoplexy: characteristics, treatment, and outcomes. Neurosurg Focus 2004; 16 (04) E6
    CrossrefPubMedSearch in Google Scholar
  • 7 Rutkowski MJ, Kunwar S, Blevins L, Aghi MK. Surgical intervention for pituitary apoplexy: an analysis of functional outcomes. J Neurosurg 2018; 129 (02) 417-424
    CrossrefPubMedSearch in Google Scholar
  • 8 Oldfield EH, Merrill MJ. Apoplexy of pituitary adenomas: the perfect storm. J Neurosurg 2015; 122 (06) 1444-1449
    CrossrefPubMedSearch in Google Scholar
  • 9 Biousse V, Newman NJ, Oyesiku NM. Precipitating factors in pituitary apoplexy. J Neurol Neurosurg Psychiatry 2001; 71 (04) 542-545
    CrossrefPubMedSearch in Google Scholar
  • 10 Lenthall R, Gonugunta V, Jaspan T. Pituitary apoplexy with optic tract oedema and haemorrhage in a patient with idiopathic thrombocytopenic purpura. Neuroradiology 2001; 43 (02) 156-158
    CrossrefPubMedSearch in Google Scholar
  • 11 Maïza JC, Bennet A, Thorn-Kany M, Lagarrigue J, Caron P. Pituitary apoplexy and idiopathic thrombocytopenic purpura: a new case and review of the literature. Pituitary 2004; 7 (03) 189-192
    CrossrefPubMedSearch in Google Scholar
  • 12 Tsuji T, Mochinaga H, Yamasaki H, Tsuda H. Primary immune thrombocytopenia accompanied by pituitary apoplexy [in Japanese]. Rinsho Ketsueki 2016; 57 (07) 877-880
    PubMedSearch in Google Scholar
  • 13 Wongpraparut N, Pleanboonlers N, Suwattee P. et al. Pituitary apoplexy in a patient with acute myeloid leukemia and thrombocytopenia. Pituitary 2000; 3 (02) 113-116
    CrossrefPubMedSearch in Google Scholar
  • 14 Kruljac I, Cerina V, Pećina HI. et al. Pituitary metastasis presenting as ischemic pituitary apoplexy following heparin-induced thrombocytopenia. Endocr Pathol 2012; 23 (04) 264-267
    CrossrefPubMedSearch in Google Scholar