Pituitary apoplexy following laparascopic cholocystectomy

Abstract

A 67 years old male patient was admitted to our clinic with the complaints of severe headache, lethargy, decreased vision in both eyes which started on the same day immediately after an elective laparascopic cholecystectomy operation. His emergency cranial magnetic resonance imaging revealed a big pituitary mass lesion, with heterogenous intensity compressing both cavernous sinuses and suprasellar cistern (Fig. 1). When questioned, the patient stated that he had had blurred vision and frontal headache during the last 2 years. After the evaluation of blood electrolytes and hypophysial hormone status which revealed serum prolactin level of 1250ng=ml (normal: <25ng=ml), he was immediately taken to operation and the hemorrhagic adenoma later reported as a prolactinoma with apoplexy was grossly totally excised via a trans-Slyvian approach. Transcranial, trans-Slyvian approach was chosen to explore both optic nerves. Both optic nerves were decompressed. In the preoperative period, there was nearly bilateral amorosis with only slight light perception in the left eye. In the postoperative period, vision was improved and found to be 3=6 in both eyes with bitemporal hemianopia. He was discharged 3 weeks after surgery on hormone replacement and dopamine agonist therapy. Postoperative serum prolactin levels 5 months after surgery were found to be 20ng=ml (normal) and his vision was 4=6 in both eyes. Discussion

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