Bursting lesion in a confined space

Ismail, Mohd Helmie and Kori, Mohamad Asyraf and Saiful Suhardi, Mohd Iman and Mohd Junit, Mohd Nadzrul Shah (2025) Bursting lesion in a confined space. In: Tripartite Congress 2025: 58th Malaysia-Singapore Congress of Medicine, 5th AMM-AMS-HKAM Tripartite Congress of Medicine & 7th Emergency Medicine Annual Symposium (EMAS), 22nd August 2025, Kuala Lumpur, Malaysia.

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Abstract

Introduction: Pituitary apoplexy is a potentially life-threatening but rare case that results from complications of pituitary gland or tumors causing hemorrhage or infarction. It presents with subtle symptoms that may be missed during first presentation due to mild presentation and wide range of differential diagnosis. Case Description: 49-year-old gentlemen presented with persistent headache for the past 6 days associated with non-vertiginous dizziness and nausea. The headache was throbbing in nature and not resolved by painkiller. He also had blurring of vision and discomfort over left eye. He seek treatment at private clinic at day 2 of illness but was discharged with migraine medications. His symptoms were not resolved and he went to emergency department for further evaluation. On examination, he was alert and conscious and hydration was fair. His vital signs were normal. On eye examination, pupils were bilaterally reactive and RAPD was negative. His left eye had hypertropia and exotropia on natural gaze with no diplopia. For his bilateral eye vision, his right eye was 6/24 and left eye was hand movement. Otherwise, other cranial nerves were normal. Neurological assessment of bilateral upper limb and lower limb were unremarkable except his gait was broad base during walking. Urgent plain and contrasted brain CT with CT Angiogram and CT Venogram revealed Large sellar mass with suprasellar extension associated with intralesional hemorrhagic component causing mass effect, with the lesion suggesting pituitary macroadenoma complicated with apoplexy. For blood investigation results revealed all normal. Acute pituitary surgery was done in view of clinical symptoms of acute headache and visual disturbance. Discussion: Diagnosis of Pituitary apoplexy depends on clinical symptoms, thorough physical examination and neuroimaging findings. The most common symptoms are headache consists of 82% of cases, visual disturbances with 39% of the cases, and nausea with 36% of cases. It may presents with hypopituitarism due to rapid decline of pituitary function such as vascular collapse due to decreased level of ACTH and cortisol but it occurs only in 55% of cases. Conclusion: Headache is the most common symptoms for pituitary apoplexy. The thorough examination on visual disturbance is important to decide further neuroimaging evaluation.

Item Type:	Proceeding Paper (Poster)
Uncontrolled Keywords:	Pituitary apoplexy, headache, pituitary macroadenoma
Subjects:	R Medicine > RC Internal medicine > RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine Kulliyyah of Medicine > Department of Emergency Medicine Sultan Ahmad Shah Medical Centre (SASMEC)
Depositing User:	Dr Mohd Helmie Ismail
Date Deposited:	27 Mar 2026 15:17
Last Modified:	27 Mar 2026 15:17
Queue Number:	2026-03-Q2661
URI:	http://irep.iium.edu.my/id/eprint/124055

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