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1.
J Med Case Rep ; 15(1): 544, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1496217

ABSTRACT

BACKGROUND: This report describes the case of a patient whose pituitary microadenoma resolved after he contracted coronavirus disease 2019. To our knowledge, this is one of the first reported cases of pituitary tumor resolution due to viral illness. We present this case to further investigate the relationship between inflammatory response and tumor remission. CASE PRESENTATION: A 32-year-old man in Yemen presented to the hospital with fever, low blood oxygen saturation, and shortness of breath. The patient was diagnosed with coronavirus disease 2019. Past medical history included pituitary microadenoma that was diagnosed using magnetic resonance imaging and secondary adrenal insufficiency, which was treated with steroids. Due to the severity of coronavirus disease 2019, he was treated with steroids and supportive care. Three months after his initial presentation to the hospital, brain magnetic resonance imaging was performed and compared with past scans. Magnetic resonance imaging revealed changes in the microadenoma, including the disappearance of the hypointense lesion and hyperintense enhancement observed on the previous scan. CONCLUSIONS: Pituitary adenomas rarely undergo spontaneous resolution. Therefore, we hypothesized that tumor resolution was secondary to an immune response to coronavirus disease 2019.


Subject(s)
Adenoma , COVID-19 , Pituitary Neoplasms , Adenoma/complications , Adenoma/diagnostic imaging , Adult , Humans , Magnetic Resonance Imaging , Male , Pituitary Neoplasms/diagnostic imaging , Pituitary Neoplasms/drug therapy , SARS-CoV-2
2.
BMJ Case Rep ; 14(7)2021 Jul 28.
Article in English | MEDLINE | ID: covidwho-1331803

ABSTRACT

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-2
3.
Endocr J ; 68(4): 477-484, 2021 Apr 28.
Article in English | MEDLINE | ID: covidwho-1204140

ABSTRACT

We provide the details of the successful management of a patient with active Cushing's disease complicated with coronavirus disease 2019 (COVID-19) pneumonia. The patient was a 27-year-old Japanese female healthcare worker who was scheduled to undergo pituitary surgery for Cushing's disease. She had been in close contact with an undiagnosed patient infected with COVID-19 and then developed COVID-19 pneumonia. Despite a lack of known risk factors associated with severe COVID-19 infection, the patient's dyspnea worsened and her respiratory condition deteriorated, as indicated by the need for 7 L/min oxygen supply by mask to maintain her oxygen saturation at >90%. Medical treatment was initiated to control hypercortisolism by the 'block and replace' regimen using steroidogenesis inhibitors and hydrocortisone. The COVID-19 pneumonia improved with multi-modal treatment including antiviral therapy. One month later, after a negative severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) test result and with appropriate protection against virus transmission to medical staff in the operating room and daily medical care nurses, trans-sphenoidal surgery was performed by our highly experienced pituitary surgeon. One month after the surgery, the patient's basal ACTH and cortisol levels and urinary free cortisol were all under the detection limit. Surgical remission was expected. Since hypercortisolism due to active Cushing's disease may worsen a COVID-19 infection, multi-disciplinary management that includes appropriate and prompt treatment strategies is mandatory in such cases.


Subject(s)
Amides/administration & dosage , Benzamidines/administration & dosage , COVID-19/therapy , Guanidines/administration & dosage , Metyrapone/administration & dosage , Pituitary ACTH Hypersecretion/therapy , Pregnenediones/administration & dosage , Pyrazines/administration & dosage , ACTH-Secreting Pituitary Adenoma/complications , ACTH-Secreting Pituitary Adenoma/drug therapy , Adenoma/complications , Adenoma/drug therapy , Adult , COVID-19/complications , COVID-19/pathology , Combined Modality Therapy , Dihydrotestosterone/administration & dosage , Dihydrotestosterone/analogs & derivatives , Disease Progression , Female , Health Personnel , Heparin/administration & dosage , Humans , Japan , Neurosurgical Procedures , Pituitary ACTH Hypersecretion/blood , Pituitary ACTH Hypersecretion/complications , Pituitary ACTH Hypersecretion/pathology , SARS-CoV-2/physiology , Treatment Outcome , Trimethoprim, Sulfamethoxazole Drug Combination/administration & dosage
6.
Eur J Endocrinol ; 183(1): G1-G7, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-256412

ABSTRACT

Clinical evaluation should guide those needing immediate investigation. Strict adherence to COVID-19 protection measures is necessary. Alternative ways of consultations (telephone, video) should be used. Early discussion with regional/national experts about investigation and management of potential and existing patients is strongly encouraged. Patients with moderate or severe clinical features need urgent investigation and management. Patients with active Cushing's syndrome, especially when severe, are immunocompromised and vigorous adherence to the principles of social isolation is recommended. In patients with mild features or in whom a diagnosis is less likely, clinical re-evaluation should be repeated at 3 and 6 months or deferred until the prevalence of SARS-CoV-2 has significantly decreased; however, those individuals should be encouraged to maintain social distancing. Diagnostic pathways may need to be very different from usual recommendations in order to reduce possible exposure to SARS-CoV-2. When extensive differential diagnostic testing and/or surgery is not feasible, it should be deferred and medical treatment should be initiated. Transsphenoidal pituitary surgery should be delayed during high SARS-CoV-2 viral prevalence. Medical management rather than surgery will be the used for most patients, since the short- to mid-term prognosis depends in most cases on hypercortisolism rather than its cause; it should be initiated promptly to minimize the risk of infection in these immunosuppressed patients. The risk/benefit ratio of these recommendations will need re-evaluation every 2-3 months from April 2020 in each country (and possibly local areas) and will depend on the local health care structure and phase of pandemic.


Subject(s)
Coronavirus Infections/prevention & control , Cushing Syndrome/therapy , Enzyme Inhibitors/therapeutic use , Glucocorticoids/therapeutic use , Infection Control/methods , Neurosurgical Procedures/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Telemedicine , 14-alpha Demethylase Inhibitors/therapeutic use , ACTH-Secreting Pituitary Adenoma/complications , ACTH-Secreting Pituitary Adenoma/diagnosis , ACTH-Secreting Pituitary Adenoma/therapy , Adenoma/complications , Adenoma/diagnosis , Adenoma/therapy , COVID-19 , Coronavirus Infections/transmission , Cushing Syndrome/diagnosis , Cushing Syndrome/etiology , Cushing Syndrome/immunology , Disease Management , Humans , Hydrocortisone/blood , Immunocompromised Host , Ketoconazole/therapeutic use , Metyrapone/therapeutic use , Patient Education as Topic , Pneumonia, Viral/transmission , Practice Guidelines as Topic , Severity of Illness Index , Time Factors
7.
Neurosurgery ; 87(2): E140-E146, 2020 08 01.
Article in English | MEDLINE | ID: covidwho-71966

ABSTRACT

BACKGROUND AND IMPORTANCE: A pituitary adenoma patient who underwent surgery in our department was diagnosed with COVID-19 and 14 medical staff were confirmed infected later. This case has been cited several times but without accuracy or entirety, we feel obligated to report it and share our thoughts on the epidemic among medical staff and performing endonasal endoscopic surgery during COVID-19 pandemic. CLINICAL PRESENTATION: The patient developed a fever 3 d post endonasal endoscopic surgery during which cerebrospinal leak occurred, and was confirmed with SARS-CoV-2 infection later. Several medical staff outside the operating room were diagnosed with COVID-19, while the ones who participated in the surgery were not. CONCLUSION: The deceptive nature of COVID-19 results from its most frequent onset symptom, fever, a cliché in neurosurgery, which makes it hard for surgeons to differentiate. The COVID-19 epidemic among medical staff in our department was deemed as postoperative rather than intraoperative transmission, and attributed to not applying sufficient personal airway protection. Proper personal protective equipment and social distancing between medical staff contributed to limiting epidemic since the initial outbreak. Emergency endonasal endoscopic surgeries are feasible since COVID-19 is still supposed to be containable when the surgeries are performed in negative pressure operating rooms with personal protective equipment and the patients are kept under quarantine postoperatively. However, we do not encourage elective surgeries during this pandemic, which might put patients in conditions vulnerable to COVID-19.


Subject(s)
Adenoma/surgery , Coronavirus Infections/transmission , Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data , Neuroendoscopy/methods , Pituitary Neoplasms/surgery , Pneumonia, Viral/transmission , Adenoma/complications , Aged , Betacoronavirus , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Elective Surgical Procedures , Epidemics , Humans , Lung/diagnostic imaging , Male , Nasal Cavity , Natural Orifice Endoscopic Surgery , Neurosurgical Procedures/methods , Operating Rooms , Pandemics , Patient Isolation , Pituitary Neoplasms/complications , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Postoperative Care , SARS-CoV-2 , Tomography, X-Ray Computed
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