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

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Chinese Neurosurgical Journal 2023年第4期9卷 320-325页

作者： Aysha Gomaa robert skelly East Sussex Healthcare NHS Trust EastbourneUK East Suffolk and North Essex NHS Foundation Trust ColcchesterUK

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

关键词： Pituitary apoplexy Pituitary macroadenoma Chronic lymphocytic leukaemia Chemotherapy

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