The role of the biochemistry department in the diagnosis of pituitary apoplexy

Ann Clin Biochem 2004;41:162-165
doi:10.1258/000456304322880096
© 2004 Association for Clinical Biochemistry

This Article
Right arrow

Full Text (PDF)

Right arrow
Alert me when this article is cited
Right arrow
Alert me if a correction is posted
Services
Right arrow
Email this article to a friend
Right arrow

Similar articles in this journal

Right arrow
Similar articles in PubMed
Right arrow
Alert me to new issues of the journal
Right arrow
Download to citation manager
Right arrow
Citing Articles
Right arrow
Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow
Articles by Williams, H R T
Right arrow
Articles by Thomas, D J B
Right arrow Search for Related Content
PubMed
Right arrow
PubMed Citation
Social Bookmarking

What’s this?

Case Reports


H R T Williams,
N S Oliver,
F Murphy,
M Howell,
M K Badman,
R M Hillson and
D J B Thomas


Department of Medicine, The Hillingdon Hospital, Uxbridge UB8 3NN, UK;
Department of Medicine, The Hillingdon Hospital, Uxbridge UB8 3NN, UK;
Department of Clinical Biochemistry, The Hillingdon Hospital, Uxbridge UB8 3NN, UK;
Department of Clinical Biochemistry, The Hillingdon Hospital, Uxbridge UB8 3NN, UK;
Department of Medicine, The Hillingdon Hospital, Uxbridge UB8 3NN, UK;
Department of Medicine, The Hillingdon Hospital, Uxbridge UB8 3NN, UK;
Department of Medicine, The Hillingdon Hospital, Uxbridge UB8 3NN, UK

A 47-year-old man presented with severe clinical hypoglycaemia.He had long-standing insulin-dependent diabetes with previouslygood glycaemic control. Intense headaches and vomiting initiatedhospitalization. A brain computed tomography (CT) scan was normal,and a lumbar puncture showed elevated cerebrospinal fluid (CSF)protein [0.67 g/L; normal range (NR) 0.15-0.45 g/L], suggestingresolving viral meningitis.

Routine thyroid function tests were abnormal (free thyroxine10.6 pmol/L, NR 9-22.5 pmol/L; thyroid-stimulating hormone 0.16mU/L, NR 0.35-5 mU/L). In the absence of evident thyroid therapy,the laboratory policy required an urgent cortisol assay to beadded; this was very abnormal (42 nmol/L), suggesting hypopituitarism.Later analysis showed that concentrations of gonadotrophinsand adrenocorticotrophin were low. An urgent pituitary magneticresonance imaging scan revealed an unsuspected pituitary tumourwith recent haemorrhage (pituitary apoplexy). The patient wasgiven intravenous hydrocortisone and then stabilized on oralhydrocortisone, thyroxine and mesterolone. He made a full recoveryand the hypoglycaemia resolved.

The normal brain CT scan was falsely reassuring and the CSFprotein was not due to viral meningitis but to haemorrhage intothe pituitary tumour. If laboratory policy had not requiredthe urgent cortisol assay be added, the diagnosis of hypopituitarismwould have been delayed or even missed altogether. This couldhave led to the death of the patient.


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What’s this?






This article has been cited by other articles:

Home page Ann Clin BiochemHome page

D. Preiss, L. Todd, and M. Panarelli
Diagnosing unsuspected hypopituitarism in adults from suggestive thyroid function test results
Ann Clin Biochem,

January 1, 2008;
45(1):
70 – 75.

[Abstract]
[Full Text]
[PDF]