Prolactinoma with apoplexy in the context of thrombocytopaenia: A case report

Oliver Chow; Therese Pham; Brandon He; Amy Hort; Damien Gibson; Gemma Olsson

doi:10.1016/j.ijscr.2022.107228

Prolactinoma with apoplexy in the context of thrombocytopaenia: A case report

Int J Surg Case Rep. 2022 Jun:95:107228. doi: 10.1016/j.ijscr.2022.107228. Epub 2022 May 20.

Authors

Oliver Chow¹, Therese Pham², Brandon He³, Amy Hort⁴, Damien Gibson⁵, Gemma Olsson⁶

Affiliations

¹ Westmead Hospital Plastics and Reconstructive Department, Australia.
² Liverpool Hospital Plastics and Reconstructive Department, Australia.
³ University of New South Wales, Australia.
⁴ Westmead Hospital General Surgical Department, Australia.
⁵ Westmead Hospital, Australia.
⁶ Westmead Hospital Neurosurgery Department, Australia.

Abstract

Introduction and importance: Pituitary apoplexy is a clinical syndrome that occurs secondary to abrupt haemorrhage or infarction and can cause a presentation with headache, visual disturbances, and various neurological deficits. Pituitary apoplexy is a rare clinical syndrome that is often misdiagnosed or discovered late in its clinical course due to its relatively nonspecific clinical presentation.

Case presentation: The case describes patient with a giant prolactinoma which developed haemorrhagic progression in the context of previously undiagnosed coagulopathy from idiopathic thrombocytopaenia. Transcranial (rather than transnasal) surgery was performed for evacuation and debulking.

Conclusion: The case highlights the management of an exceedingly large adenoma in the context of coagulopathy contributing to rapid clinical progression, as well as a positive clinical outcome in a patient with restored vision and pituitary function.

Keywords: Giant macroadenoma; Pituitary apoplexy; Prolactinoma; Thrombocytopaenia.