Endocrine Abstracts

Introduction

The COVID-19 pandemic has significantly affected health systems all over the world, putting on a hold medical care and delaying surgical interventions. Patients with pituitary tumors, especially those who associate hormonal hypersecretion or defficiency and mass effects represent a management challenge even in a non-pandemic time.

Case description

A 41 years old, non-smoker, overweight, male patient was admitted in our clinic for bitemporal hemianopsia, diplopia, diziness and erectile dysfunction, symptoms that had started six months prior. The patient did not associate other comorbidities. The magnetic resonance examination of the pituitary showed a large mass of 30.9/40.5/29.4 mm, with sellar and parasellar extension, invasion of the left cavernous sinus and compression the optic chiasm. Preoperatively, the hormonal profile revealed hypogonadotroph hypogonadism and no other hormonal deficiencies. We reccommended neurosurgical resection of the tumor, but during the hospitalization in our clinic he was diagnosed with SARS-CoV-2 infection which delayed the surgical intervention. The patient showed minimal COVID-19 symptoms, no lung damage and was referred to a COVID-19 support center, where he received symptomatic treatment and remained until the RT-PCR assay for SARS-CoV-2 was negative. Transsphenoidal surgery was performed, with favorable post-operative evolution and no complications. The histopathological exam established the diagnosis of pituitary non-functioning macroadenoma. Our patient underwent transsphenoidal intervention 9 days after he was discharged from de COVID-19 supportive center and was negative for SARS-CoV-2 (17 days after diagnosis). The post-operative pituitary MRI showed a tumor remnant of 19/33/25 mm. The hormonal evaluation showed persistence of gonadotroph pituitary insufficiency, with no other hormonal abmormalities and with visual field improvement. We started substitutive therapy with testosterone undecanoate, 1000 mg i.m. every 3 months, with good clinical response.

Conclusion

So far, there is no consensus on the management of the pituitary patients which associate COVID-19, only recommendations for several emergencies, including pituitary apoplexy and adrenal crisis. Endonasal pituitary surgery for SARS-CoV-2 positive patients is considered a high risk intervention and it must be postponed, except for major emergencies. The evolution of our patient was positive, without significant impact on disease progression of the delayed intervention.