Pituitary Apoplexy and Idiopathic Thrombocytopenic Purpura: A New Case and Review of the Literature

Abstract

Pituitary apoplexy can occur as a complication of idiopathic thrombocytopenic purpura. We report here a new case of such association. A male patient aged 59 years, complaining of decreased libido for one year, was referred to the emergency department for purpura and severe thrombocytopenia (4000 platelets/mm3). 24 hours after the cutaneous rash the patient presented with clinical symptoms of bilateral cavernous sinus compression comprising ptosis, bilateral ophtalmoplegia and right supraorbital hypoesthesia. Cranial CT scan showed an enlarged sella and a pituitary mass with signs of intrapituitary haemorrhage. Hormonal evaluation showed hyperprolactinemia (50 ng/mL) and hypopituitarism, and the patient needed substitution with hydrocortisone and levothyroxine. Immunoglobulins and corticosteroids were given to the patient to treat thrombocytopenia, then worsening of neurological and ophtalmological symptoms led to pituitary surgery. Histopathological examination found necrotical pituitary tissue. Immunostaining with an anti-prolactin antibody was positive in several groups of cells. Neurological symptoms subsided and thrombocytopenia was corrected by treatment. In conclusion, we report a case of pituitary apoplexy due to severe thrombocytopenia occurring as a complication of a preexisting macroprolactinoma.

Concomitant Pituitary Apoplexy and Acute Fatty Liver of Pregnancy Complicated With Disseminated Intravascular Coagulation

“…The latter, however, is not uncommon in patients with AFLP who frequently have fluctuations in blood pressure or lose significant blood during the peripartum period, potentially increasing the risk of pituitary apoplexy. To further support the role of bleeding diathesis in the risk of pituitary apoplexy is the evidence from many reported cases of pituitary apoplexy associated with thrombocytopenia irrespective of DIC (12)(13)(14)(15)(16). In addition to thrombocytopenia, our patient had significantly reduced antithrombin III levels (approximately 20% below the normal limit).…”

Pituitary Apoplexy-Like Disease in 4 Dogs

“…Although pituitary apoplexy most commonly occurs with macroadenomas, apoplectic events have occurred with Rathke cleft cysts, as well as with nontumorous pituitary glands. 2,7,9,10 In the present work, clinical, clinico-pathologic, and imaging features were related to PDH due to a macroadenoma in dogs 1, 2, and 3. Similar to the previously described case, 17 the tumors in dogs 1, 2, and 3 of this report were identified as ACTH-producing adenomas.…”

“…Thrombocytopenia and ITP are extrinsic factors usually associated with human pituitary tumoral hemorrhage. 9,10 However, no evidence of a tumor was found in this dog.…”

UK guidelines for the management of pituitary apoplexy

“…Anticoagulation therapy, 24 coagulopathies, 25 initiation or withdrawal of dopamine receptor agonists, 26 oestrogen therapy, 27 radiation therapy, 12 pregnancy 28 and head trauma 29 are some of the other factors known to instigate pituitary apoplexy.…”