Immune Thrombocytopenic Purpura Complicated by Pituitary Apoplexy: 5th Case Worldwide

Background: Pituitary apoplexy (PA) is an uncommon condition that may arise as a consequence of immune thrombocytopenic purpura (ITP). It is typically observed in the context of pituitary adenoma. The condition may manifest with symptoms of intracranial hypertension, namely, headaches of a "helmet-like" character, visual acuity decline, and vertigo. This case report describes a rare occurrence of pituitary apoplexy in a patient diagnosed with immune thrombocytopenic purpura (ITP). Aim: Despite the rarity of this pathological coexistence, it highlights the potential link between immune thrombocytopenic purpura (ITP) and the emergence of pituitary apoplexy (PA). Case description: A 34-year-old male patient with no previous medical history, referred to the hospital with hemorrhagic symptoms, including epistaxis and gingivorrhagia. Lab tests revealed a severe thrombocytopenia of 1,000 elements/mm³. Etiological investigation set up a diagnosis of ITP, and platelet transfusion along as intravenous immunoglobulin therapy were initiated. Subsequently, the patient presented to the emergency department with ptosis, diplopia, a sudden decline of visual acuity, and headaches. Cerebral imaging showed a pituitary adenoma with signs of hemorrhage and compression of the optic chiasm. A conservative management approach was therefore adopted and the clinical course was characterized by the involution of the ischemic adenomatous material, development of an empty Sella turcica, persistence of the other pituitary hormones deficiency and the resolution of the polyuria-polydipsia syndrome. Platelet counts returned to normal following the initiation of treatment. Result: The patient was satisfied after the improvement of ophthalmological symptoms and the resolution of thrombocytopenia after treatment. Conclusion: We presented a rare emergence of ITP with severe thrombocytopenia complicated by apoplexy of a pituitary macroadenoma. This case highlights the critical importance of considering pituitary apoplexy in the differential diagnosis when evaluating patients with ITP.