Endocrine Abstracts

Background: Pituitary apoplexy is a rare complication of pituitary adenomas, especially nonfunctioning tumors. It is associated with severe headache, which may be accompanied by visual disturbances or ocular palsy. Here we present two patients who suffered from pituitary adenoma apoplexy while receiving anticoagulation therapy with non-vitamin K antagonists.

Case presentation: A 74-year old woman was diagnosed with a non-functioning pituitary macroadenoma measuring 20×30×30 mm. In addition to arterial hypertension and essential thrombocytemia, her medical history included atrial fibrillation, for which anticoagulant therapy (dabigatran) had been initiated. One month later the patient presented with severe headache and vertigo due to pituitary apoplexy associated with subarrachnoid hemorrhage. There were no signs of pituitary insufficiency. She was managed conservatively and a brain MRI performed three months later revealed shrinkage of the pituitary mass. The second patient was a 69-year old man with arterial hypertension, coronary artery disease and arterial fibrillation who was taking apixaban. Three years after initiation of anticoagulation treatment the patient presented to the emergency department with severe headache, vomiting and complete ocular palsy of his right eye. An MRI showed apoplexy of pituitary macroadenoma with compression of the right oculomotor nerve. The patient underwent urgent transsphenoidal surgery but, although pituitary mass was completely removed, no improvement of neurological symptoms was observed.

Conclusion: These cases show that anticoagulantion treatment sholud be used with caution in patients with pituitary macroadenoma. Therefore, further stuides are needed to determine the safest anticoagulation treatment option in these patients.