Pituitary apoplexy secondary to dengue hemorrhagic fever in acromegaly: Case report and literature review

Pituitary apoplexy (PA) is a rare clinical syndrome caused by acute hemorrhage or infarction within an undiagnosed pituitary tumor. Predisposing factors include systemic hypertension, surgery, head injury, coagulopathies, and certain drugs. However, reports linking dengue hemorrhagic fever (DHF) with PA in acromegaly are rare. This case describes a 34-year-old male with acromegalic features—mandibular prognathism, broad nose, thick lips, and prominent supraorbital ridges—who developed PA secondary to DHF. He presented with blurred vision, ptosis, headache, exotropia, and ophthalmoplegia one week after recovering from DHF. Magnetic resonance imaging and hormonal studies confirmed pituitary apoplexy and acromegaly. The patient was treated with corticosteroids and urgent transsphenoidal decompression, followed by octreotide acetate therapy. Early recognition and prompt management are crucial as pituitary apoplexy can lead to permanent visual loss and even death due to hemodynamic instability. This case highlights DHF as a rare precipitating factor for PA in acromegaly.