Subject(s)
Adenoma , COVID-19 , Pituitary Apoplexy , Pituitary Neoplasms , Humans , Magnetic Resonance Imaging , Pituitary Apoplexy/diagnosis , SARS-CoV-2ABSTRACT
Objective: Since the outbreak of the COVID-19 pandemic, several cases of pituitary apoplexy (PA) following a SARS-CoV-2 infection have been described in several countries. Here, we describe a case series of PA occurring in the aftermath of a SARS-CoV-2 infection to alert physicians about possible neuro-endocrinological damage caused by the virus that can lead to visual sequelae and hypopituitarism. Design and methods: We retrospectively identified all the adult patients treated at Amiens University Hospital between March 2020 and May 2021 for PA confirmed by cerebral imaging and following an RT-PCR-confirmed SARS-CoV-2 infection. Results: Eight cases (six women, two men) occurred between March 2020 and May 2021 and were reviewed in this study. The mean age at diagnosis was 67.5 ± 9.8 years. Only one patient had a 'known' non-functional pituitary macroadenoma. The most common symptom of PA was a sudden headache. Brain imaging was typical in all cases. Only two patients required decompression surgery, whereas the others were managed conservatively. The clinical outcome was favorable for all patients but without recovery of their pituitary deficiencies. There was no diabetes insipidus. Conclusion: This case series, the largest in the literature, reinforces the strength, consistency, and coherence of the association between SARS-CoV-2 infection and PA. Our study provides support for the hypothesis that SARS-CoV-2 may be a new precipitating factor for PA. It is essential that practitioners be alerted about possible pituitary disease due to the virus so that such patients are recognized and appropriately managed, hence improving their prognosis.
Subject(s)
COVID-19 , Hypopituitarism , Pituitary Apoplexy , Pituitary Neoplasms , Adult , COVID-19/complications , Female , Hospitals, University , Humans , Hypopituitarism/complications , Male , Pandemics , Pituitary Apoplexy/diagnosis , Pituitary Neoplasms/surgery , Retrospective Studies , SARS-CoV-2ABSTRACT
Pituitary apoplexy is an endocrine emergency, which commonly presents as hypopituitarism. Prompt diagnosis and treatment can be both life and vision saving. There are a growing number of published case reports postulating a link between COVID-19 and pituitary apoplexy. We report the case of a 75-year-old man who presented with a headache and was later diagnosed with hypopituitarism secondary to pituitary apoplexy. This occurred 1 month following a mild-to-moderate COVID-19 infection with no other risk factors commonly associated with pituitary apoplexy. This case, therefore, supplements an emerging evidence base supporting a link between COVID-19 and pituitary apoplexy.
Subject(s)
Adenoma , COVID-19 , Pituitary Apoplexy , Pituitary Neoplasms , Stroke , Adenoma/complications , Adenoma/diagnosis , Aged , Humans , Male , Pituitary Apoplexy/diagnosis , Pituitary Apoplexy/etiology , Pituitary Neoplasms/complications , Pituitary Neoplasms/diagnosis , SARS-CoV-2ABSTRACT
COVID-19 is a respiratory virus, which has affected various organ systems as well. Here we report a neuro-ophthalmic presentation of pituitary apoplexy under the setting of COVID-19 infection in a middle-aged man who presented to ophthalmic emergency with sudden bilateral loss of vision along with a history of fever past 10 days. There was sluggishly reacting pupils and RT-PCR for COVID was positive. Imaging pointed the diagnosis as pituitary macroadenoma with apopexy. In view of pandemic situation, patient was given symptomatic treatment as per the protocols and stabilized. Vision also showed improvement to some extent and the patient is awaiting neurosurgery.
Subject(s)
Adenoma/diagnosis , COVID-19/diagnosis , Eye Infections, Viral/diagnosis , Pituitary Apoplexy/diagnosis , Pituitary Neoplasms/diagnosis , SARS-CoV-2 , Adenoma/drug therapy , Adenoma/virology , Eye Infections, Viral/drug therapy , Eye Infections, Viral/virology , Glucocorticoids/therapeutic use , Humans , Magnetic Resonance Imaging , Male , Methylprednisolone/therapeutic use , Middle Aged , Pituitary Apoplexy/drug therapy , Pituitary Apoplexy/virology , Pituitary Neoplasms/drug therapy , Pituitary Neoplasms/virology , COVID-19 Drug TreatmentABSTRACT
Patients with pituitary tumours, ensuing hormonal abnormalities and mass effects are usually followed in multidisciplinary pituitary clinics and can represent a management challenge even during the times of non-pandemic. The COVID-19 pandemic has put on hold routine medical care for hundreds of millions of patients around the globe, while many pituitary patients' evaluations cannot be delayed for too long. Furthermore, the majority of patients with pituitary tumours have co-morbidities potentially impacting the course and management of COVID-19 (e.g. hypopituitarism, diabetes mellitus, hypertension, obesity and cardiovascular disease). Here, we summarize some of the diagnostic and management dilemmas encountered, and provide guidance on safe and as effective as possible delivery of care in the COVID-19 era. We also attempt to address how pituitary services should be remodelled in the event of similar crises, while maintaining or even improving patient outcomes. Regular review of these recommendations and further adjustments are needed, depending on the evolution of the COVID-19 pandemic status. We consider that the utilization of successful models of pituitary multidisciplinary care implemented during the COVID-19 pandemic should continue after the crisis is over by using the valuable and exceptional experience gained during these challenging times.