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Case Reports
. 2020 Dec;23(6):716-720.
doi: 10.1007/s11102-020-01080-w. Epub 2020 Sep 11.

Pituitary apoplexy associated with acute COVID-19 infection and pregnancy

Julie L Chan  1 , Kimberly D Gregory  2 , Sarah S Smithson  2 , Mariam Naqvi  2 , Adam N Mamelak  3
Affiliations
Case Reports

Pituitary apoplexy associated with acute COVID-19 infection and pregnancy

Julie L Chan et al. Pituitary. 2020 Dec.

Abstract

Purpose: We report a case of a pregnant female presenting with pituitary apoplexy and simultaneous SARS-CoV-2 infection with a focus on management decisions.

Clinical history: A 28-year-old G5P1 38w1d female presented with 4 days of blurry vision, left dilated pupil, and headache. She tested positive for SARS-CoV-2 on routine nasal swab testing but denied cough or fever. Endocrine testing demonstrated an elevated serum prolactin level, and central hypothyroidism. MRI showed a cystic-solid lesion with a fluid level in the pituitary fossa and expansion of the sella consistent with pituitary apoplexy. Her visual symptoms improved with corticosteroid administration and surgery was delayed to two weeks after her initial COVID-19 infection and to allow for safe delivery of the child. A vaginal delivery under epidural anesthetic occurred at 39 weeks. Two days later, transsphenoidal resection of the mass was performed under strict COVID-19 precautions including use of Powered Air Purifying Respirators (PAPRs) and limited OR personnel given high risk of infection during endonasal procedures. Pathology demonstrated a liquefied hemorrhagic mass suggestive of pituitary apoplexy. She made a full recovery and was discharged home two days after surgery.

Conclusion: Here we demonstrate the first known case of successful elective induction of vaginal delivery and transsphenoidal intervention in a near full term gravid patient presenting with pituitary apoplexy and acute SARS-CoV-2 infection. Further reports may help determine if there is a causal relationship or if these events are unrelated. Close adherence to guidelines for caregivers can greatly reduce risk of infection.

Keywords: COVID-19; Coronavirus; Pituitary apoplexy; Pregnancy; SARS-CoV-2.

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Conflict of interest statement

The authors have no conflicts of interests or competing interests to disclose.

Figures

Fig. 1
Fig. 1
MRI pituitary without contrast demonstrating 2.2 cm × 2.5 cm × 2.0 cm cystic solid lesion with an expanded sella turcica and hemorrhage on a sagittal T1, b coronal T2, c axial FLAIR, and d axial SWI sequences
See this image and copyright information in PMC

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