Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(04): 890-894
DOI: 10.4103/ajns.ajns_217_21
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
Department of Neurosurgery, P. D. Hinduja National Hospital and MRC, Mumbai, Maharashtra
,
Phulrenu Chauhan
1   Department of Endocrinology, P. D. Hinduja National Hospital and MRC, Mumbai, Maharashtra
,
Farhad Kapadia
2   Department of Intensive Care, P. D. Hinduja National Hospital and MRC, Mumbai, Maharashtra
,
Milind Sankhe
Department of Neurosurgery, P. D. Hinduja National Hospital and MRC, Mumbai, Maharashtra
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

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, and panhypopituitarism. 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, the 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.

Key-words:

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

Financial support and sponsorship

Nil.




Publication History

Received: 28 May 2021

Accepted: 09 August 2021

Article published online:
16 August 2022

© 2021. 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/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Briet C, Salenave S, Bonneville JF, Laws ER, Chanson P. Pituitary apoplexy. Endocr Rev 2015;36:622-45.
  • 2 Biousse V. Precipitating factors in pituitary apoplexy. J Neurol Neurosurg Psychiatry 2001;71:542-5.
  • 3 Nyenwe EA, Kitabchi AE. The evolution of diabetic ketoacidosis: An update of its etiology, pathogenesis and management. Metabolism 2016;65:507-21.
  • 4 Camara-Lemarroy CR, Infante-Valenzuela A, Rodriguez-Velver K, Rodriguez-Gutierrez R, Villareal-Velazquez HJ. Pituitary apoplexy presenting as diabetic ketoacidosis: A great simulator? Neuro Endocrinol Lett 2016;37:9-11.
  • 5 Zipser S, Kirsch CM, Lien C, Singh TM, Kang YS. Acute aortoiliac and femoral artery thrombosis complicating diabetic ketoacidosis. J Vasc Interv Radiol 2005;16:1737-9.
  • 6 Jiang HJ, Hung WW, Hsiao PJ. A case of acromegaly complicated with diabetic ketoacidosis, pituitary apoplexy, and lymphoma. Kaohsiung J Med Sci 2013;29:687-90.
  • 7 Thomas N, Scanlon J, Ahmed M. Supraventricular tachycardia in association with diabetic ketoacidosis. Br J Diabetes Vasc Dis 2007;7:244-5.
  • 8 Faruqi TA, Hanhan UA, Orlowski JP, Laun KS, Williams AL, Fiallos MR. Supraventricular tachycardia with underlying atrial flutter in a diabetic ketoacidosis patient. Clin Diabetes 2015;33:146-9.
  • 9 Finn BP, Fraser B, O'Connell SM. Supraventricular tachycardia as a complication of severe diabetic ketoacidosis in an adolescent with new-onset type 1 diabetes. BMJ Case Rep 2018;2018:bcr-2017-222861.
  • 10 Lin KD, Hsieh MC, Hsin SC, Hsaio ZY, Hung WW, Shin SJ. Acute brachial artery thrombosis: A rare complication of diabetic ketoacidosis. Kaohsiung J Med Sci 2006;22:44-8.
  • 11 Sohinki D, Obel OA. Current trends in supraventricular tachycardia management. Ochsner J 2014;14:586-95.