Beyond the Infarct: The Silent Sellar Surprise
https://doi.org/10.15605/jafes.041.S1
- Author:
Siti Nabilah Afni Pakururazi
1
;
Ilham Ismail
2
;
Mahrunissa Mahadi
2
;
Norlaila Mustafa
3
;
Norasyikin A. Wahab
3
Author Information
1. Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia;Department of Medicine, Hospital Canselor Tuanku Muhriz;Ministry of Health Malaysia
2. Department of Medicine, Hospital Canselor Tuanku Muhriz
3. Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia;Department of Medicine, Hospital Canselor Tuanku Muhriz
- Publication Type:Journal Article
- MeSH:
Infarction
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):91-92
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Pituitary apoplexy is a rare, life-threatening endocrine
emergency caused by acute hemorrhage or infarction
of the pituitary, often in the setting of a pre-existing
adenoma (2–12%). While classically presenting with
sudden headache, visual loss, and altered consciousness,
it can occasionally mimic an acute stroke. Occurrence after
coronary procedures is exceptionally rare, particularly
when accompanied by cerebral infarction. We report
a middle-aged male who developed an acute stroke
following percutaneous coronary intervention (PCI)
and subsequently had panhypopituitarism secondary to
pituitary apoplexy.
Case:A 50-year-old male, with underlying diabetes mellitus,
hypertension, dyslipidemia, and chronic kidney disease
stage G3A, initially admitted to a private centre for PCI,
however, complicated with acute left-sided weakness,
headache, and reduced consciousness 2 days postprocedure. He had a history of progressive left visual loss
for 3 months. Examination revealed Glasgow Coma Scale
E2V4M4, blood pressure 118/82 mmHg, left-sided power
4/5, and temporal pallor of the left optic disc. His blood
sugar was 15.5 mmol/L. Urgent computer tomography scan of the brain
demonstrated a right basal ganglia infarct with sellar mass
measuring 15 × 15 × 20 mm extending into the suprasellar
cistern with mass effect. Magnetic resonance imaging
confirmed multifocal acute and chronic infarcts with an
acute pituitary hemorrhage compressing the optic chiasm.
Biochemistry showed mild acute kidney injury (urea
11.7 mmol/L, creatinine 119 µmol/L) without electrolyte
imbalance, thrombocytopenia, or anemia. Hormonal studies
revealed partial hypopituitarism with normal thyroid
function, secondary adrenal insufficiency (serum morning
cortisol 40 nmol/L), and central hypogonadism (serum
testosterone 2.2 nmol/L). Hydrocortisone was initiated
inpatient, followed later by testosterone replacement and
antiplatelet therapy during follow-up.
Conclusion:This case illustrates pituitary apoplexy with an atypical
presentation: acute neurological deficits following invasive
cardiovascular procedures. It underscores the importance of
multidisciplinary management involving endocrinologists,
cardiologists, neurologists, and neurosurgeons to optimize
outcomes. Early recognition, prompt neuroimaging,
and timely treatment are vital to prevent irreversible
neurological and endocrine complications.
- Full text:2026080415025502898EP_A130.pdf
