Madhusudhan Savitha, Madhusudhan Thayur R, Haslett Roger S, Sinha Amit
St, Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK.
J Med Case Rep. 2011 Jul 5;5:284. doi: 10.1186/1752-1947-5-284.
Pituitary apoplexy following a major surgical procedure is a catastrophic event and the diagnosis can be delayed in a previously asymptomatic patient. The decision on thromboprophylaxis in shoulder replacements in the absence of definite guidelines, rests on a careful clinical judgment.
A previously healthy 62-year-old Caucasian male patient who underwent shoulder arthroplasty developed hyponatremia resistant to correction with saline replacement. The patient had a positive family history of deep vein thrombosis and pulmonary embolism and heparin thromboprophylaxis was considered on clinical grounds. The patient developed hyponatremia resistant to conventional treatment and later developed ocular localizing signs with oculomotor nerve palsy. The diagnosis was delayed due to other confounding factors in the immediate post-operative period. Subsequent workup confirmed a pituitary adenoma with features of pituitary insufficiency. The patient was managed successfully on conservative lines with a multidisciplinary approach.
A high index of suspicion is required in the presence of isolated post-operative hyponatremia resistant to medical correction. A central cause, in particular pituitary adenoma, should be suspected early. Thromboprophylaxis in shoulder replacements needs careful consideration as it may be a contributory factor in precipitating this life-threatening condition.
重大外科手术后发生垂体卒中是一种灾难性事件，对于既往无症状的患者，诊断可能会延迟。在缺乏明确指南的情况下，肩部置换术中血栓预防的决策取决于仔细的临床判断。
一名62岁健康的白种男性患者接受肩部置换术后出现对生理盐水补充治疗无效的低钠血症。该患者有深静脉血栓形成和肺栓塞的家族史阳性，基于临床考虑给予肝素进行血栓预防。该患者出现对传统治疗无效的低钠血症，随后出现动眼神经麻痹的眼部定位体征。由于术后早期存在其他混淆因素，诊断被延迟。随后的检查证实为垂体腺瘤并伴有垂体功能减退的特征。该患者通过多学科方法成功进行了保守治疗。
对于存在孤立的术后对药物纠正无效的低钠血症情况，需要高度怀疑。应早期怀疑中枢性病因，尤其是垂体腺瘤。肩部置换术中的血栓预防需要仔细考虑，因为它可能是引发这种危及生命状况的一个促成因素。
