%0 Journal Article
%T Pituitary apoplexy following shoulder arthroplasty: a case report
%A Savitha Madhusudhan
%A Thayur R Madhusudhan
%A Roger S Haslett
%A Amit Sinha
%J Journal of Medical Case Reports
%D 2011
%I BioMed Central
%R 10.1186/1752-1947-5-284
%X A previously healthy 62-year-old Caucasian male patient who underwent shoulder arthroplasty developed hyponatremia resistant to correction with saline replacement. The patient had a positive family history of deep vein thrombosis and pulmonary embolism and heparin thromboprophylaxis was considered on clinical grounds. The patient developed hyponatremia resistant to conventional treatment and later developed ocular localizing signs with oculomotor nerve palsy. The diagnosis was delayed due to other confounding factors in the immediate post-operative period. Subsequent workup confirmed a pituitary adenoma with features of pituitary insufficiency. The patient was managed successfully on conservative lines with a multidisciplinary approach.A high index of suspicion is required in the presence of isolated post-operative hyponatremia resistant to medical correction. A central cause, in particular pituitary adenoma, should be suspected early. Thromboprophylaxis in shoulder replacements needs careful consideration as it may be a contributory factor in precipitating this life-threatening condition.Pituitary apoplexy resulting from an acute hemorrhage or infarction of the pituitary gland usually occurs in a macroadenoma. The rapid increase in tumor volume results in an abrupt onset of a variable combination of neurological symptoms and signs including headache, vomiting, ocular nerve palsies, visual field defects, visual acuity impairment, Horner's syndrome, stroke, meningism, stupor and coma as well as endocrine dysfunction.A 62-year-old Caucasian male patient was admitted for right total shoulder replacement for an arthritic shoulder. He was on treatment with non-steroidal anti-inflammatory medication for pain relief, a thiazide diuretic, calcium channel blocker and beta blockers for hypertension, and low dose aspirin for cardioprotection. There was a family history of deep vein thrombosis and pulmonary embolism. He was a non-smoker and did not consume alcohol. His systemic
%U http://www.jmedicalcasereports.com/content/5/1/284