BACKGROUND: Pituitary apoplexy is a life-threatening endocrine emergency that is caused by haemorrhage or infarction of the pituitary gland, commonly within a pituitary adenoma. Patients classically present with headache, ophthalmoplegia, visual field defects and altered mental state, but may present with a typical symptoms such as fever and altered conscious level. CASE PRESENTATION: A 57-year-old female with a known pituitary macroadenoma was treated for suspected acute coronary syndrome with aspirin, clopidogrel and full dose enoxaparin. She developed a severe and sudden headache, nausea and vomiting and visual deterioration. A CT scan showed haemorrhage into the pituitary macroadenoma. She underwent neurosurgical decompression. Post-operatively her visual fields and acuity returned to baseline. She was continued on hydrocortisone and thyroxine replacement on discharge. CONCLUSION: This case illustrates the risks of anticoagulation in a patient with a known pituitary macroadenoma, and raises the issue of whether these tumours present a relative contraindication to the use of dual antiplatelet and anticoagulation in acute coronary syndrome.
BACKGROUND: Pituitary apoplexy is a life-threatening endocrine emergency that is caused by haemorrhage or infarction of the pituitary gland, commonly within a pituitary adenoma. Patients classically present with headache, ophthalmoplegia, visual field defects and altered mental state, but may present with a typical symptoms such as fever and altered conscious level. CASE PRESENTATION: A 57-year-old female with a known pituitary macroadenoma was treated for suspected acute coronary syndrome with aspirin, clopidogrel and full dose enoxaparin. She developed a severe and sudden headache, nausea and vomiting and visual deterioration. A CT scan showed haemorrhage into the pituitary macroadenoma. She underwent neurosurgical decompression. Post-operatively her visual fields and acuity returned to baseline. She was continued on hydrocortisone and thyroxine replacement on discharge. CONCLUSION: This case illustrates the risks of anticoagulation in a patient with a known pituitary macroadenoma, and raises the issue of whether these tumours present a relative contraindication to the use of dual antiplatelet and anticoagulation in acute coronary syndrome.
Authors: Ron J G Peters; Shamir R Mehta; Keith A A Fox; Feng Zhao; Basil S Lewis; Steven L Kopecky; Rafael Diaz; Patrick J Commerford; Vicent Valentin; Salim Yusuf Journal: Circulation Date: 2003-09-22 Impact factor: 29.690
Authors: C Leyer; F Castinetti; I Morange; M Gueydan; C Oliver; B Conte-Devolx; H Dufour; T Brue Journal: J Endocrinol Invest Date: 2010-08-31 Impact factor: 4.256
Authors: L Giammattei; G Mantovani; G Carrabba; S Ferrero; A Di Cristofori; E Verrua; C Guastella; L Pignataro; P Rampini; M Minichiello; M Locatelli Journal: J Endocrinol Invest Date: 2016-01-05 Impact factor: 4.256