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Open access

Milad Darrat, Brian Gilmartin, Carmel Kennedy, and Diarmuid Smith


Acute respiratory distress syndrome (ARDS) is a rare but life-threatening complication of diabetic ketoacidosis (DKA). We present the case of a young female, with no previous diagnosis of diabetes, presenting in DKA complicated by ARDS requiring extra corporeal membrane oxygenation (ECMO) ventilator support. This case report highlights the importance of early recognition of respiratory complications of severe DKA and their appropriate management.

Learning points

  • ARDS is a very rare but life-threatening complication in DKA.
  • The incidence of ARDS remains unknown but less frequent than cerebral oedema in DKA.
  • The mechanism of ARDS in DKA has multifactorial aetiology, including genetic predisposition.
  • Early recognition and consideration of rare pulmonary complication of DKA can increase survival rate and provide very satisfactory outcomes.
  • DKA patients who present with refractory ARDS can be successfully rescued by ECMO support.
Open access

Milad Darrat, Mohammad Binhussein, Alan Beausang, Clare Faul, Michael W O’Reilly, Mohsen Javadpour, and Amar Agha

Pituitary adenomas are the commonest sellar tumours. Pituitary metastases are very rare, with the most common primaries being breast and lung cancers. We report the case of an 83-year-old man with a history of breast carcinoma who presented with recent-onset headaches and progressive deterioration of visual acuity. MRI brain showed a large sellar and suprasellar mass compressing the optic chiasm and involving the pituitary stalk. Transsphenoidal debulking resulted in symptomatic relief and visual recovery. Specimen examination revealed a combination of a gonadotroph pituitary adenoma that was infiltrated by metastatic breast carcinoma. He had no symptoms of diabetes insipidus. He was subsequently treated with pituitary radiotherapy. This is a very rare presentation of a pituitary mass with mixed pathology. To our knowledge, this is the third description of a breast carcinoma metastasis into a gonadotroph cell pituitary adenoma.

Learning points:

  • Infiltrating metastases into pituitary adenomas are very rare but do occur.
  • To our knowledge this is the third case of breast adenocarcinoma metastasising to a gonadotroph pituitary adenoma.
  • Pituitary metastases should always be considered in rapidly evolving pituitary symptoms in a cancer patient.
  • Not all complex pituitary lesions are associated with panhypopituitarism.
  • Early invasive local management (TSS and post TSS radiotherapy) can provide rapid satisfactory outcomes.