Research Day

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INTRODUCTION: Pituitary apoplexy is an uncommon condition that results from infarction and hemorrhage of an established pituitary adenoma. Based on our review of the literature, this is the first description of pituitary apoplexy presenting after a knife stab wound to the deltopectoral region. 
CASE PRESENTATION: A 44 year-old male presented to the trauma bay as a tier 1 trauma activation status post stabbing to the left deltopectoral groove. The patient was found to be hypotensive, tachycardic and actively exsanguinating from the stab wound. He was taken to the operating room where the wound was explored and the left cephalic vein was ligated. Patient tolerated the procedure well and was discharged two days post-operatively. Patient returned to the hospital on post-operative day four with a severe frontal headache. While in the emergency room, the patient quickly decompensated and was found to have ptosis on the left, abducens nerve palsy and anisocoria. MRI displayed a large pituitary macroadenoma with intra-mass hemorrhage filling the suprasellar cistern and invading the left cavernous sinus. Patient underwent an emergent transsphenoidal endoscopic pituitary resection. The post-operative course was unremarkable and the patient was found to have only mild symptoms of hypogonadism at his one month follow up which were successfully treated with hormone replacement.
CONCLUSION: Pituitary apoplexy is a rare complication of a pituitary adenoma. This case report exhibits an extremely rare occurrence of pituitary apoplexy after a penetrating traumatic event to the chest that was successfully treated via transsphenoidal endoscopic pituitary resection.



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