Endocrine Abstracts

Introduction

Pituitary apoplexy is seen in 1.5–27.7% of pituitary adenomas. Common etiologies include hypertension, diabetes mellitus, radiotherapy, contrast-enhanced MR, surgery, drugs, anticoagulant, antithrombotic, estrogen, head trauma and pregnancy. SARS-CoV-2 had spread rapidly, and caused COVID-19 pandemic. Although it mainly causes respiratory problems, there may also be extrapulmonary involvement. COVID-19 infection is associated with hemorrhagic complications, cardiac and renal infarction and cerebrovascular hemorrhage. In this report, we present a patient who was followed up with microprolactinoma and developed hemorrhagic degeneration in adenoma after Covid-19 infection.

Case

A 26-year-old female patient was found to have serum prolactin of 94.19 mg/l (4.79–25.3) in the tests performed due to menstrual irregularity and complaints of galactorrhea by provocation. Control prolactin was 104 mg/l, and macroprolactin was negative. Other anterior pituitary hormones, kidney and liver function tests were normal. A 4 × 6 mm microadenoma was detected on pituitary gland in pituitary MRI. Cabergoline 0.5 mg/week was initiated in March 2019 with the diagnosis of microprolactinoma. The pituitary MRI taken in February 2021 revealed a 7 × 5.5 mm lesion in the adenohypophysis with the presece of hemorrhagic degeneration. There were no complaints of severe headache, nausea, vomiting, or visual impairment during system inquiry. Anterior pituitary hormone levels were normal. Medical history showed that she was diagnosed with Covid-19 in September 2020. She used hydroxychloroquine sulfate 2 × 200 mg (5 days) and enoxaparin sodium 2 × 0.6 mg (10 days) and then acetylsalicylic acid for 10 days. It was thought that hemorrhagic degeneration might be due to the antiaggregant/antithrombotic treatment she had received or the Covid-19 infection itself.

DISCUSSION

Case reports of pituitary apoplexy following Covid-19 infection have been presented in the literature. It is unclear whether this infection occurs as a contributing factor to pituitary apoplexy or coincidentally. It is possible that coronavirus infection could cause an acute hemorrhagic infarction of the gland. This risk increases with anticoagulant and antiaggregant treatments used during Covid-19 infection. Although bleeding into adenomas is spesific to macroadenomas, it should be kept in mind that it may also occur with microadenomas.