Sheehan's like syndrome in a man
File(s)
Accepted version
Author(s)
Almazrouei, Raya
Model, Douglas
Meeran, Karim
Type
Journal Article
Abstract
An 84-year-old physician self-diagnosed that he had a pituitary tumour when he was found to have a bilateral upper quadrantanopia on routine eye testing. Magnetic resonance imaging (MRI) confirmed a large non-functioning pituitary macroadenoma associated with chiasmal compression. Investigation showed partial hypopituitarism with disconnection hyperprolactinaemia [prolactin 1095 mU/L (60–300)]. He was treated with hormonal replacement consisting of thyroxin 100 µg and prednisolone 3 mg and was offered transphenoidal hypophysectomy, but chose a conservative approach. Two years later, his visual fields worsened (Figure 1A) corresponding to an increase in macrodenoma size. Subsequently, he fell and fractured his left shoulder, which became infected, requiring surgery. Immediately after the shoulder surgery, he became hypotensive and vomited several times, and his visual fields became restricted. MRI showed pituitary infarction (Figure 1B), and he did not require surgical intervention. A few weeks later, he noticed dramatic improvement in his vision. His prolactin level dropped from a peak level of 1095 to 48 mU/L (60–300), suggesting lactotroph infarction. Repeated pituitary MRI showed dramatic reduction in the height of the pituitary macroadenoma consistent with the improvement in his visual fields (Figure 1C).
Date Issued
2019-10
Date Acceptance
2019-03-16
Citation
QJM: An International Journal of Medicine, 2019, 112 (10), pp.811-812
ISSN
1460-2393
Publisher
Oxford University Press (OUP)
Start Page
811
End Page
812
Journal / Book Title
QJM: An International Journal of Medicine
Volume
112
Issue
10
Copyright Statement
© The Author(s) 2019. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For permissions, please email: journals.permissions@oup.com. This is a pre-copy-editing, author-produced version of an article accepted for publication in QJM: An International Journal of Medicine following peer review. The definitive publisher-authenticated version is available online at: https://academic.oup.com/qjmed/advance-article/doi/10.1093/qjmed/hcz071/5419860
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30911765
PII: 5419860
Subjects
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
General & Internal Medicine
11 Medical and Health Sciences
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2019-03-26