Abstract

INTRODUCTION Pituitary apoplexy  is an endocrine  emergency, commonest cause is pituitary adenoma .It can occur with or without precipitating factors .Commonest precipitating factor is hypertension. • Post traumatic pituitary apoplexy due to tumor infarction is not common. CASE REPORT 58 year old male Nigerian painter presented with sudden loss of consciousness, sudden headache and weakness in the upper and lower limbs following fall from three meters high ladder while painting a house..Hehad a preceding history of poor vision in his right  eye. No headache and no vomiting. He was not hypertensive or diabetic. His social  and family history  was unremarkable. Also married with five children. Presented with laceration in the occipital region. His  Glasgow coma scale was 10 ( eye opening 3, verbal response 3 and motor response 4). The power in all limbs  is 4.. Pupils were sluggishly reactive to light. His pulse rate was 93 beats per minutes and blood pressure was 155/103mmHg. Also noticed to have slurred speech after regaining consciousness within 10 minutes of fall.. Initial assessment was Traumatic  Brain  injury to rule out Stroke. His Brain CT scan (non contrast) showed pituitary fossa hemorrhage and hemorrhagic sellar/suprasellarmass suggestive of apoplectic pituitary macroadenoma.. While on admission he developed persistent hypoglycemia. Hormonal profile showed low basal cortisol of  99nmol/L, low ACTH  of 0.5pmol/L, low LH of 0.9u/L, and thyroid function test suggestive of hypothyroidism. Visual acuity showed no light perception on the right eye and 20cm visual acuity on the left eye. Serum electrolytes and renal function were essential normal. An assessment of Hypopituitarism secondary to post traumatic pituitary apoplexy with C5 quadriparesiswas made. He was commenced on intramuscular hydrocortisone 100mg every 6 hours. Repeat  basal cortisol and RBG level was normal. He was changed to  oral prednisolone 5mg am and 2.5mg pm and  tabs  levothyroxine after discontinuation of hydrocortisone. Further care was hampered by severe financial constraint and he was lost to follow up.
BRAIN CT SCAN(NON CONSTRAST
CONCLUSION Pituitary apoplexy could be precipitated by head trauma with or without pituitary tumor. High index of suspicion is needed to avoid missed diagnosi