Ohara Nobumasa, Yoneoka Yuichiro, Seki Yasuhiro, Akiyama Katsuhiko, Arita Masataka, Ohashi Kazumasa, Suzuki Kazuo, Takada Toshinori
Department of Endocrinology and Metabolism, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4132 Urasa, Minamiuonuma, Niigata, 949-7302, Japan.
Department of Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan.
J Med Case Rep. 2017 Aug 24;11(1):235. doi: 10.1186/s13256-017-1371-7.
Pituitary tumor apoplexy is a rare clinical syndrome caused by acute hemorrhage or infarction in a preexisting pituitary adenoma. It typically manifests as an acute episode of headache, visual disturbance, mental status changes, cranial nerve palsy, and endocrine pituitary dysfunction. However, not all patients present with classical symptoms, so it is pertinent to appreciate the clinical spectrum of pituitary tumor apoplexy presentation. We report an unusual case of a patient with pituitary tumor apoplexy who presented with periorbital edema associated with hypopituitarism.
An 83-year-old Japanese man developed acute anterior hypopituitarism; he showed anorexia, fatigue, lethargy, severe bilateral periorbital edema, and mild cardiac dysfunction in the absence of headache, visual disturbance, altered mental status, and cranial nerve palsy. Magnetic resonance imaging showed a 2.5-cm pituitary tumor containing a mixed pattern of solid and liquid components indicating pituitary tumor apoplexy due to hemorrhage in a preexisting pituitary adenoma. Replacement therapy with oral hydrocortisone and levothyroxine relieved his symptoms of central adrenal insufficiency, central hypothyroidism, periorbital edema, and cardiac dysfunction.
Common causes of periorbital edema include infections, inflammation, trauma, allergy, kidney or cardiac dysfunction, and endocrine disorders such as primary hypothyroidism. In the present case, the patient's acute central hypothyroidism was probably involved in the development of both periorbital edema and cardiac dysfunction. The present case highlights the need for physicians to consider periorbital edema as an unusual predominant manifestation of pituitary tumor apoplexy.
垂体瘤卒中是一种由既往存在的垂体腺瘤急性出血或梗死引起的罕见临床综合征。其典型表现为急性发作的头痛、视力障碍、精神状态改变、颅神经麻痹和垂体内分泌功能障碍。然而，并非所有患者都表现出典型症状，因此了解垂体瘤卒中的临床谱很有必要。我们报告了一例不寻常的垂体瘤卒中患者，其表现为伴有垂体功能减退的眶周水肿。
一名83岁的日本男性出现急性垂体前叶功能减退；他表现出厌食、疲劳、嗜睡、严重的双侧眶周水肿和轻度心脏功能障碍，无头痛、视力障碍、精神状态改变和颅神经麻痹。磁共振成像显示一个2.5厘米的垂体瘤，包含实性和液体成分的混合模式，提示既往垂体腺瘤出血导致垂体瘤卒中。口服氢化可的松和左甲状腺素替代治疗缓解了他的中枢肾上腺功能不全、中枢性甲状腺功能减退、眶周水肿和心脏功能障碍症状。
眶周水肿的常见原因包括感染、炎症、创伤、过敏、肾脏或心脏功能障碍以及内分泌紊乱，如原发性甲状腺功能减退。在本病例中，患者的急性中枢性甲状腺功能减退可能与眶周水肿和心脏功能障碍的发生有关。本病例强调医生需要将眶周水肿视为垂体瘤卒中一种不寻常的主要表现。
