The post operative anterior pituitary dysfunction results from excessive aspiration of the sella, inappropriate manipulation and removal of the normal gland along with the adenoma as well as damage due to the bipolar coagulation.20 In the macroadenoma, the rest of the pituitary land is compressed and thinned thus making it difficult to differentiate adenoma from the normal gland and may result in its damage.21 Post operative new anterior pituitary insufficiency
affecting one axis or more than one axis was observed in 60% to 14% by Gondim et al.
Ishii et al., "A case of IgG4-related hypophysitis without pituitary insufficiency
," The Journal of Clinical Endocrinology & Metabolism, vol.
Our patient suffered from both neurotoxic and hematotoxic features immediately after the event and presented 4 weeks later with features of pituitary insufficiency
. Our patient developed syndrome 5, as per the criterion given by WHO in 2010.
Also, posterior lobe pituitary insufficiency
was confirmed with levels of vasopressin and copeptin  in the low-normal range at the presence of high urine output with a low urine osmolality and high serum sodium (for detailed laboratory values, see Table 1).
Patients with suprasellar lesions commonly present with visual field defects, pituitary insufficiency
, and symptoms of raised intracranial pressure.
CONSEQUENCES: Pituitary insufficiency
may have serious consequences, possibly aggravating the physical and neuropsychiatric morbidity observed after TBI:
Although the most common presentation is a pituitary insufficiency
in both of these lymphomas, hypopituitarism is seen more often in PPL (73.7%) than SPL (41.2%), but there is no statistically significant difference.
Other common space-occupying effects of intracranial aneurysm include visual field deficits (contralateral homonymous hemianopia) in relation to compression of the optic tract, mental derangements if the aneurysm compresses the mammillary bodies, and pituitary insufficiency
if the aneurysm grows into the sella turcica .
PA often occurs spontaneously in pituitary macroadenomas and may be associated with varying degrees of pituitary insufficiency
(3) A life-threatening pituitary insufficiency
or an acute adrenal crisis may occur.
The syndrome of inappropriate antidiuresis is a diagnosis of exclusion that can be established only if diuretic use and adrenal, thyroid, and pituitary insufficiency