Pituitary apoplexy after cardiac surgery in a patient with subclinical pituitary adenoma: case report with review of literature
Affiliations- department of neurosurgery
- Acibadem Hospital, Department of Pathology, Istanbul/TURKEY, 34718 Istanbul, Türkiye
open access
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
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.
Keywords
pituitary apoplexy, Sheehan' s syndrome, cardiac surgery, pituitary adenoma
About this articleTitle
Pituitary apoplexy after cardiac surgery in a patient with subclinical pituitary adenoma: case report with review of literature
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
520-525
Page views
252
Article views/downloads
310
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
