Pituitary Apoplexy Secondary to Thrombocytopenia due to Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Report of a Rare Case and Literature Review

Abstract

Purpose: To report a 16-year-old female patient with pituitary apoplexy in the setting of coronavirus disease 2019 (COVID-19) infection-related thrombocytopenia in the absence of preexisting pituitary macroadenoma.

Methods: The patient had been admitted because of respiratory complications of COVID-19 infection and developed thrombocytopenia, intense headache, and symptoms of cavernous sinus syndrome.

Results: Urgent magnetic resonance imaging of the brain depicted a pituitary apoplexy.

Conclusion: This case indicated that thrombocytopenia due to COVID-19 could be a predisposing factor for pituitary apoplexy in the absence of underlying pituitary disease.

Keywords: Coronavirus disease 2019; Pituitary apoplexy; Severe acute respiratory syndrome coronavirus 2; Thrombocytopenia.

Figure 1

Partial left ophthalmoplegia and ptosis

Figure 2

Unremarkable magnetic resonance (MR) venogram of the brain, with no evidence of venous sinus thrombosis (a). Coronal T2-weighted brain MR image depicts an asymmetrically expanded left cavernous sinus (blue arrow) (b). Precontrast sagittal T1-weighted brain MR image shows signal hyperintensity due to blood collection within the pituitary gland (red arrow) (c). Precontrast sagittal T1-weighted brain MR image demonstrates an approximately 15 mm × 20 mm sellar lesion without compression of the optic chiasm (green circle) (d)