Gupta Rahul, Bhattacharjee Urmimala, Lekshmon K S, Chaudhary Shakun, Sharma Prashant, Jandial Aditya, Dutta Pinaki
Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Case Rep Endocrinol. 2021 Dec 28;2021:6086756. doi: 10.1155/2021/6086756. eCollection 2021.
Thrombocytopenia as a precipitating factor for pituitary apoplexy (PA) is very rare event. There are only five reported cases of PA secondary to thrombocytopenia caused by underlying haematological malignancy. Herein, we report a case of 60-year-old male presenting with acute-onset headache, bilateral vision loss, and ptosis. Computed tomography and magnetic resonance imaging revealed findings indicative of pituitary adenoma with apoplexy. He was noted to have thrombocytopenia, and bone marrow evaluation revealed precursor B-lineage CALLA-positive acute lymphoblastic leukemia. Accordingly, he was started on dexamethasone and vincristine but succumbed to -related hospital-acquired pneumonia two weeks after initiation of chemotherapy. We performed a literature search and found five cases of pituitary apoplexy secondary to haematological malignancy-related thrombocytopenia. The usual age of presentation was in the 6 to 7 decade, and there was slight male preponderance. The underlying pituitary adenoma was either nonfunctioning or a prolactinoma, and in majority, the apoplexy event occurred after the diagnosis of haematological malignancy. The platelet counts at the time of PA were less than 30 × 10/L in all, and the malignancy subtypes were acute or chronic myeloid leukemia and chronic lymphoid leukemia. The current case highlights the importance of careful evaluation for the cause of thrombocytopenia in a case of PA.
血小板减少作为垂体卒中（PA）的诱发因素是非常罕见的事件。仅有5例继发于潜在血液系统恶性肿瘤所致血小板减少的垂体卒中报告病例。在此，我们报告1例60岁男性，表现为急性起病的头痛、双侧视力丧失和上睑下垂。计算机断层扫描和磁共振成像显示符合垂体腺瘤伴卒中的表现。他被发现有血小板减少，骨髓评估显示为前体B淋巴细胞系CALLA阳性急性淋巴细胞白血病。因此，他开始接受地塞米松和长春新碱治疗，但在化疗开始两周后死于医院获得性肺炎。我们进行了文献检索，发现5例继发于血液系统恶性肿瘤相关血小板减少的垂体卒中病例。通常发病年龄在60至70岁，男性略占优势。潜在的垂体腺瘤为无功能腺瘤或泌乳素瘤，大多数情况下，卒中事件发生在血液系统恶性肿瘤诊断之后。所有垂体卒中病例发生时血小板计数均低于30×10⁹/L，恶性肿瘤亚型为急性或慢性髓系白血病以及慢性淋巴细胞白血病。本例强调了在垂体卒中病例中仔细评估血小板减少原因的重要性。
