Pituitary Apoplexy Leading to Stress-Related Cardiomyopathy and Ischemic Stroke—A Case Report

Pituitary apoplexy is a clinical syndrome resulting from sudden hemorrhage or infarction of the pituitary gland, mainly within the pituitary adenoma. Pituitary apoplexy can rarely lead to stress-related cardiomyopathy, which can cause fatal complications like thrombus formation, arrhythmias, and cardiac arrest. We present a rare case of a patient presenting with pituitary apoplexy, stress-related cardiomyopathy, and ischemic stroke due to underlying left ventricular thrombus formation. A 54-year-old male patient presented to the short-day emergency care (SDEC) in early September with complaints of feeling slightly unwell and occasional headaches. His investigations showed hyponatremia and low cortisol, and his CT head showed a significant contrast-enhancing macro adenoma (approximately 20*21*23 mm) arising from the pituitary fossa with suprasellar extension. A few days after his admission, he was found to have new ECG changes, and a contrast-enhanced echocardiography revealed the typical features of a stress-related cardiomyopathy with a left ventricular thrombus inside. He developed an ischemic stroke as a result, and it was managed with the involvement of multiple specialties. Our case report echoes the urgency of detecting a PA early, and the fact that PA can lead to SRC must be considered. This case also reflects one of the major complications of SRC, thrombus formation and subsequent stroke. Early recognition prompts treatment with steroids, and proper anti-coagulation helped to bring him back to baseline.