Acute kidney injury with severe hyperkalaemia requiring haemodialysis in a patient with pituitary apoplexy - a case report

Background. Pituitary apoplexy is an endocrine emergency caused by acute haemorrhage within a pituitary tumour. Common presentations are acute onset headache, vomiting and neuro-ophthalmic manifestations. Corticotroph deficiency is a life-threatening complication resulting in severe haemodynamic instability if not promptly corrected. Case report. A 48 years old patient, diagnosed of having acromegaly with pituitary macro adenoma presented to local hospital with a 3-day history of headache, vomiting and altered consciousness. He had hypotension and was resuscitated with fluids only for 1 day and was transferred to TH-Kandy. On transfer his GCS was 14/15 with bilateral proptosis and ophthalmoplegia. Patient was tachycardic and blood pressure was 76/40 mmHg. He had hypoglycaemia and metabolic acidosis with normal electrolytes. NCCT brain revealed bleeding into the pituitary macroadenoma. Hydrocortisone was commenced on admission with fluid resuscitation. Blood pressure improved rapidly. Neurosurgical team recommended conservative management. The following day he developed Acute Kidney Injury with S. Cr 7.6 mg/dL and potassium 7.9 mmol/L. Haemodialysis was arranged due to worsening hyperkalaemia. On day 5 his neuro-ophthalmic manifestations improved along with renal functions, requiring no further haemodialysis. Subsequently he was discharged on hydrocortisone with further follow up arranged. Conclusion. High degree of clinical suspicion should be there in a patient with pituitary tumour is coming classic symptoms. Corticotroph deficiency may be life threatening. Thus, empiric initiation of steroid on clinical suspicion is essential to prevent the subsequent hemodynamic consequences.