Pituitary macroadenoma apoplexy as a rare complication of Bruton tyrosine kinase inhibitor in chronic lymphoid leukaemia

作     者：Aysha Gomaa Robert Skelly 

作者机构：East Sussex Healthcare NHS TrustEastbourneUK East Suffolk and North Essex NHS Foundation TrustColcchesterUK 

出 版 物：《Chinese Neurosurgical Journal》 (中华神经外科杂志（英文）)

年 卷 期：2023年第9卷第4期

页      面：320-325页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Pituitary apoplexy Pituitary macroadenoma Chronic lymphocytic leukaemia Chemotherapy 

摘      要：Background Pituitary apoplexy is a neurosurgical emergency and is a known yet rare complication of pituitary *** typically present with visual field defects,headache and altered *** are multiple risk factors for this complication and a thorough drug history is essential to exclude iatrogenic causes of *** present an extremely rare case of newly diagnosed pituitary insufficiency unveiled by ibrutinib therapy(a Bruton tyrosine kinase inhibitor).Furthermore,after initial withdrawal of ibrutinib because of the erroneous diagnosis of Syndrome of Inappropriate Antidiuretic Hormone Secretion(SIADH),its re-administration led to the development of classical pituitary apoplexy 4 months after treatment was *** presentation A male patient in his 60s with a background of chronic lymphocytic leukaemia(CLL)on ibrutinib and venetoclax presents with acute confusion and deranged *** is found to be hyponatraemic and is diagnosed with Syndrome of Inappropriate Antidiuretic Hormone Secretion(SIADH)and treated with fluid *** represents again 3 weeks later with hyponatraemia and further investigations reveal pituitary insufficiency and *** was restarted on ibrutinib and venetoclax at the time of *** months later,he presents with sudden retro-orbital headache associated with *** findings include cranial nerve III,IV and XI ***’s visual field examination revealed a left visual field index(VFI)of only 1%while the right was 64%with temporal *** pupils were mid-dilated and poorly reactive to *** pituitary with contrast showed features of pituitary apoplexy and optic nerve *** was urgently referred to the neurosurgical team and underwent an emergency trans-sphenoidal hypophysectomy with circumferential excision of the ***-operative recovery was uneventful with marked improvement in vision *** patient was restarted on ibruti