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CC BY-NC-ND 4.0 · Asian J Neurosurg 2022; 17(01): 095-099
DOI: 10.1055/s-0042-1748833
Case Report

Pituitary Apoplexy Following Severe Diabetic Ketoacidosis, With Two Uncommon Complications of Supraventricular Tachycardia and Acute Limb Ischemia in a Patient with Neglected Pituitary Adenoma and Undiagnosed Diabetes Mellitus: A Rare Clinical Association

Sanjeev Pattankar
1   Department of Neurosurgery, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
,
Phulrenu Chauhan
2   Department of Endocrinology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
,
Farhad Kapadia
3   Department of Intensive Care, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
,
Milind Sankhe
1   Department of Neurosurgery, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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Abstract

Pituitary apoplexy (PA) is a clinical emergency arising from acute ischemia or hemorrhage of the pituitary gland. A small subset of pituitary adenomas present with an apoplectic crisis, with common symptoms being headache, nausea/vomiting, visual impairment, ophthalmoplegia, altered sensorium, panhypopituitarism, etc. Though diabetic ketoacidosis (DKA) is an established complication of uncontrolled diabetes mellitus, its association with PA is extremely rare. Likewise, supraventricular tachycardia (SVT) and acute limb ischemia (ALI) have rare, reported association with DKA. We present one such case of rare associations seen in our clinical practice. A 20-year-old woman was brought to our emergency room with headache, breathlessness, and altered sensorium. Clinical and biochemical evaluation revealed SVT, DKA, and right lower limb ALI. On enquiry, patient was found to be diagnosed with pituitary adenoma 2 years ago and lost to follow-up. PA was detected on neuroimaging and confirmed histopathologically. Possibility of PA presenting as DKA and its sequelae exists.

Keywords

pituitary apoplexy - uncontrolled diabetes - diabetic ketoacidosis - supraventricular tachycardia - acute limb ischemia


Publication History

Article published online:
01 June 2022

© 2022. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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