open access

Vol 44, No 5 (2010)
Other
Submitted: 2009-11-02
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Pituitary apoplexy after cardiac surgery in a patient with subclinical pituitary adenoma: case report with review of literature

Hakan Yakupoglu, Mehmet Bulent Onal, Erdinc Civelek, Atilla Kircelli, Bulent Celasun
DOI: 10.1016/S0028-3843(14)60144-4
·
Neurol Neurochir Pol 2010;44(5):520-525.

open access

Vol 44, No 5 (2010)
Other
Submitted: 2009-11-02

Abstract

Abstract

Pituitary adenoma infarction associated with cardiac surgery occurs rarely but it is a serious, life-threatening acute clinical event. Several mechanisms have been proposed but no direct cause has been clearly identified.

We report a case of pituitary apoplexy occurring in a 74-year-old patient 6 hours after cardiac surgery. The patient presented with confusion, unilateral ptosis and ophthalmoplegia. Neurological examination revealed right oculomotor nerve palsy and decreased level of consciousness. Magnetic resonance imaging showed a hemorrhagic and necrotic pituitary macroadenoma. After prompt endocrinological replacement therapy with hydrocortisone and levothyroxine, the confusion of the patient resolved. Removal of a non-functional macroadenoma with large necrotic areas resulted in full recovery.

The physician should be aware of pituitary adenoma infarction after open cardiac surgery and should remember that it can be fatal or cause permanent neurological or endocrine damage without proper treatment. Surgical and endocrine treatment can be life-saving procedures.

Abstract

Abstract

Pituitary adenoma infarction associated with cardiac surgery occurs rarely but it is a serious, life-threatening acute clinical event. Several mechanisms have been proposed but no direct cause has been clearly identified.

We report a case of pituitary apoplexy occurring in a 74-year-old patient 6 hours after cardiac surgery. The patient presented with confusion, unilateral ptosis and ophthalmoplegia. Neurological examination revealed right oculomotor nerve palsy and decreased level of consciousness. Magnetic resonance imaging showed a hemorrhagic and necrotic pituitary macroadenoma. After prompt endocrinological replacement therapy with hydrocortisone and levothyroxine, the confusion of the patient resolved. Removal of a non-functional macroadenoma with large necrotic areas resulted in full recovery.

The physician should be aware of pituitary adenoma infarction after open cardiac surgery and should remember that it can be fatal or cause permanent neurological or endocrine damage without proper treatment. Surgical and endocrine treatment can be life-saving procedures.

Get Citation

Keywords

pituitary apoplexy, Sheehan' s syndrome, cardiac surgery, pituitary adenoma

About this article
Title

Pituitary apoplexy after cardiac surgery in a patient with subclinical pituitary adenoma: case report with review of literature

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 44, No 5 (2010)

Pages

520-525

DOI

10.1016/S0028-3843(14)60144-4

Bibliographic record

Neurol Neurochir Pol 2010;44(5):520-525.

Keywords

pituitary apoplexy
Sheehan's syndrome
cardiac surgery
pituitary adenoma

Authors

Hakan Yakupoglu
Mehmet Bulent Onal
Erdinc Civelek
Atilla Kircelli
Bulent Celasun

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