Acute Lymphoblastic Leukemia Presenting as Pituitary Apoplexy: A Case Report and Review of the Literature

Table 1

Cases of pituitary apoplexy secondary to underlying haematological malignancy.

Author	N. Wongraparut et al.	Yoshinori Maki et al.	Khaled M. Krisht et al.	L. Silberstein et al.	C. C. Kingdon et al.
Age/gender	72/F	64/F	77/M	55/M	61/M
Pituitary adenoma type	Nonfunctioning	Prolactinoma	Prolactinoma	Nonfunctioning	NA
Haematological malignancy	Acute myeloid leukaemia (subtype M5B)	Chronic myeloid leukaemia	Chronic lymphoid leukaemia	Acute myeloid leukaemia	Chronic lymphoid leukaemia
Diagnosis of apoplexy preceding haematological malignancy	No	No	No	No	Yes
Platelet count	13 × 10^9/L	29 × 10^9/L	NA	19 × 10^9/L	NA
Chemotherapy	High-dose cytarabine	Cabergoline	Warfarin	NA	NA
Clinical presentation	Headache, vomiting, hypotension, b/l visual field deficit, and impairment in visual acuity	Headache, vomiting, hypotension, Rt ptosis, and Lt abducens nerve palsy	Headache, vomiting, left complete ophthalmoplegia, and diminished sensation in V1 and V2	Headache, vomiting, fever, and meningismus	Headache, fever, and altered sensorium
Lag time	12 hours	NA	48 hours	In hospital (day 6 of chemotherapy)	6 weeks
Hormone dysfunction	Hypothyroidism; hypoprolactinemia		Hypothyroidism; hypocortisolism	Hypothyroidism Hypocortisolism Hypogonadism	NA
Size of pituitary mass	1×1×1 cm	NA	4 × 3.7 × 3.7 cm	NA	NA
Management	TSS + steroids	TSS + steroids	TSS + steroids	Conservative	Conservative
Resolution of mass size	NA	Yes	NA	Yes	NA
Resolution of
1. Visual field deficit	NA	NA	NA	NA	NA
2. Visual acuity deficit	Improved	Improved	NA	NA	NA
3.Ocular paresis	NA	Resolved	Improved	NA	NA

NA: not available; TSS: transsphenoidal surgery.