An Unexpected Headache: Pituitary Apoplexy in a Patient Admitted with Diabetes Ketoacidosis (DKA)

Abstract

Background: Pituitary apoplexy is a clinical problem resulting from abrupt pituitary ischemia or hemorrhage. A small proportion of pituitary adenomas manifest as an apoplectic crisis, with pan hypopituitarism, vomiting, nausea, headache, ophthalmoplegia, and visual impairment being the most common symptoms. Case Report: A 32-year-old diabetic Asian male presented to the emergency department with symptoms of polyuria, polydipsia, persistent vomiting, and diffused abdominal pain. He also reported a recent fever and severe headache, as well as self-limited episodes of blurring of vision and diplopia three months prior. Upon admission, his vitals were stable and he was fully conscious and oriented, though irritable and anxious. On examination, he was found to have third cranial nerve palsy and a dilated pupil with no light reflex. Laboratory tests revealed diabetic ketoacidosis (DKA). A CT scan of the brain revealed a possible invasive pituitary macro adenoma and the patient was referred for further evaluation. He also tested positive for COVID-19. Treatment for DKA was initiated and an MRI scan was scheduled for further evaluation. However, the patient's condition worsened and he was transferred to the ICU, where he was intubated and an MRI indicated a hemorrhagic mass in the pituitary gland. The patient was diagnosed with pituitary apoplexy, and he also received treatment with antibiotics and antiviral medication for suspected encephalitis. Conclusion: Pituitary apoplexy is a serious condition that requires immediate evaluation and treatment. It can cause permanent damage or death if left untreated. Treatment options include surgery and conservative management with frequent monitoring.