Endocrine Abstracts

Introduction

Pituitary apoplexy (PA) consists of acute infarction/hemorrhage of the gland, involving mostly a previously unrecognized adenoma. One of its most documented precipitating factors is anticoagulation in the context of acute coronary syndrome treatment. To our knowledge only one report described a PA secondary to anticoagulation for pulmonary thromboembolism.

Case report

A 75-year-old men with known hypertension was hospitalized for bilateral pulmonary thromboembolism. At D2 of enoxaparin, complained of a sudden, strong, frontal headache. Pituitary-MRI confirmed a heterogeneous, T1-hyperintensive lesion of 28x22x26mm compatible with apoplexy. Analytical study showed hypogonadotrophic hypogonadism, high ACTH, hypercortisoluria, hypokalemia. The patient noticed tiredness, weight gain, and erectile dysfunction for 6 months, but there were no Cushing stigmata. It was decided a conservative management. At first month revaluation potassium and ACTH normalized. After three months pituitary imaging showed involution of the lesion and there were no other deficits. One year later developed hypercortisolism.

Conclusion

Considering the high prevalence of undiagnosed pituitary adenomas, physicians must be alert for risk factors for PA such as anticoagulation, used in multiple pathologies. Case reports in the context of pulmonary embolism are rare. Our case highlights the need to be aware of this emergent problem in order to prevent further complications.