Pituitary apoplexy precipitating diabetes insipidus after living donor liver transplantation |
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Authors: | Takashi Matsusaki Hiroshi Morimatsu Junya Matsumi Hiroaki Matsuda Tetsufumi Sato Kenji Sato Satoshi Mizobuchi Takahito Yagi Kiyoshi Morita |
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Institution: | (1) Department of Anesthesiology and Resuscitology, Okayama University Medical School, 2-5-1 Shikata-cho, Okayama Okayama, 700-8558, Japan;(2) Department of Surgery, Okayama University Medical School, Okayama, Japan |
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Abstract: | Pituitary apoplexy occurring after surgery is a rare but life-threatening acute clinical condition that follows extensive
hemorrhagenous necrosis within a pituitary adenoma. Pituitary apoplexy has been reported to occur spontaneously in the majority
of cases or in association with various inducing factors. Reported is a case of pituitary apoplexy complicated by diabetes
insipidus following living donor liver transplantation (LDLT). To the best of our knowledge, this has not been previously
reported. A 56-year-old woman with nonalcoholic steatohepatitis underwent LDLT from her daughter. The patient also required
dopamine support and transfusions because of massive intraoperative bleeding. Postoperatively, her coagulopathy continued,
and she underwent a second laparotomy because of unknown bleeding on postoperative day 7, when she needed transfusions and
dopamine support to maintain her vital signs. She complained of severe headache, excessive thirst, frequent urination, and
diplopia from postoperative day 10. She also had polyuria greater than 300 ml/h and was diagnosed with pituitary apoplexy
precipitating diabetes insipidus on postoperative day 13. She was treated conservatively without surgery because of the hormonally
inactive status and slight mass effect of her tumor. It is important for anesthesiologists and critical care personnel in
LDLT settings to take into consideration this complication as a differential diagnosis. |
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