Abstract Introduction Pituitary macroadenoma typically presents with gradual visual deficits, including visual field loss resulting from compression of the optic chiasm. It rarely manifests itself in an acute setting and usually does so when there is pituitary apoplexy, which is also rare in about 8% of patients with nonfunctioning pituitary macroadenoma. Case Report Patient is a 55 year old male with history of type 2 insulin dependent diabetes mellitus presenting to the hospital for shortness of breath. He was notably admitted two days ago for appendicitis and underwent appendectomy. During this admission, notable labs included venous blood gas showing pH of 7.225, elevated blood glucose of 477 Mg/dL, anion gap of 25 mmol/L, ketones of 5.3 mmol/L, and bicarbonate of 6 mmol/L, indicating patient was in diabetic ketoacidosis (DKA). He was admitted to the intensive care unit (ICU) for an insulin drip and frequent labs to monitor resolution of DKA. Within hours, he developed acute onset of right eye pain and right eye blurred vision that progressed to complete right sided vision loss. He was taken for emergent CT brain with concern of cerebral vascular accident and neurology was consulted. Radiology urgently called primary ICU team to relay imaging findings showing pituitary macroadenoma without evidence of CVA. MRI brain with pituitary protocol confirmed that the patient had a pituitary macroadenoma with hemorrhagic necrosis. Neurosurgery was consulted, recommendations included high dose steroids and plan for transsphenoidal hypophysectomy. The patient however, became progressively unstable and eventually passed with comfort care measures. Discussion Despite initially presenting with a different issue, the patient’s clinical course was further complicated by an acute change in neurological status. The initial onset of the patient’s symptoms were detected by nursing staff, thus highlighting the importance of interprofessional communication. Not only that, it is essential to assess patients at bedside when a clinical change has occurred as it can alter the trajectory of the patient’s clinical course. Conclusion Although CVA in the hospital setting is not uncommon, this case highlights the importance of maintaining a broad differential diagnosis in those with acute change in neurological status. Moreover, interprofessional communication is paramount when deciding to provide therapeutic medications that have high propensity for complications. This abstract is funded by: None
Man et al. (Fri,) studied this question.