Pituitary involvement in B-cell CLL and pituitary apoplexy, independently, are 2 rare events. Their co-occurrence in addition to the presence of prolactin-secreting adenoma cells, however, has never been described in the literature. We present the case of a combined pituitary CLL and prolactinoma apoplexy in a 77-year-old man to highlight the importance of imaging the brain in patients with CLL who present with signs and symptoms of pituitary apoplexy. To the best of our knowledge, there are only 2 other reported cases of CLL manifesting as a pituitary mass lesion.11,21 The current case is the first instance of a combined pituitary CLL-prolactinoma presenting with pituitary apoplexy. This case illustrates the need to carefully evaluate pituitary tumor specimens from patients with CLL for small lymphocytic infiltration, notwithstanding the presence of pituitary adenoma cells.
Case ReportHistory and Examination. This 77-year-old man with untreated CLL diagnosed 8 years earlier presented with a 2-day history of severe bifrontal headaches associated with nausea and vomiting, including left facial numbness and complete ophthalmoplegia of his left eye. Three weeks prior to his admission he was hospitalized at an outside hospital for a pulmonary embolus and discharged on a regimen of 5 mg of oral warfarin at bedtime along with subcutaneous injections of 115 mg of enoxaparin every 12 hours as a bridging therapy. At his initial examination at our institution, he was awake, alert, and fully oriented. Positive findings included complete dense ophthalmoplegia of the left eye, diminished facial sensation to all sensory modalities along the V1 and V2 distributions, and right eye blindness secondary to glaucoma. Visual acuity remained Combined chronic lymphocytic leukemia and prolactinoma: a rare occurrence in a patient presenting with pituitary apoplexy The authors describe a rare case of combined pituitary chronic lymphocytic leukemia (CLL) and prolactinoma in a 77-year-old man presenting with apoplexy. This case highlights the importance of evaluating the pituitary gland in patients with CLL who present with clinical manifestations of apoplexy as well as the need to carefully evaluate pathological specimens from the gland for the presence of lymphocytic cells in those patients. This is the first reported case of a combined CLL-prolactinoma pituitary lesion presenting with apoplexy.