Endocrine Abstracts

Introduction: Pituitary apoplexy is defined as the acute onset of clinical symptoms associated with hemorrhage or infarction within a normal pituitary gland or previously known pituitary adenoma.

Case report: A 47-year-old hypertensive Caucasian male patient with a known pituitary macroadenoma and family history of pituitary adenomas, was treated with thromboprophylaxis after a meniscus surgery. He was on treatment with non-steroidal anti-inflammatory medication for knee pain relief, and sartan for mild hypertension. He had been taking low molecular weight heparin for one month, but had changed the anticoagulant to dabigatran etexilate 150 mg/day, after the occurrence of deep thrombophlebitis. Over the next 3 days, the patient complained of increasing bilateral frontal headaches with the onset of binocular diplopia, drowsiness, head paresthesia and nausea. On admission, the patient was alert and had bilateral temporal hemianopia. Brain magnetic resonance imaging (MRI) showed a 1.6 cm pituitary mass with hemorrhage (apoplexy) and extension to the left cavernous sinus, with right deviation of the pituitary stalk and optic chiasm compression. Transsphenoidal resection of the tumor was done which resulted in tumor ablation and symptoms amendment.

Endocrine testing: Two weeks after transsphenoidal surgery showed thyrotroph and gonadotroph hypopituitarism. The pathology report confirmed a nonfunctional pituitary adenoma with intratumoral hemorrhage and immunohistochemistry positive for SYN and panCK, p53 < 1%, Ki-67 < 1%.

Conclusion: This case illustrates the risks of anticoagulation in patients who are already known to have a pituitary adenoma, this condition should be considered as a relative risk for anticoagulation, even with modern drugs as dabigatran.