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Case Reports
. 2022 Dec 22;14(12):e32810.
doi: 10.7759/cureus.32810. eCollection 2022 Dec.

Pituitary ​​​​Apoplexy​​ With Pituitary Macroadenoma in a Patient With ​​Asymptomatic ​​​COVID-19: ​​A Case ​​​Report

Hadi S Alyami  1 , Muhannad M Al Wadany  1 , Abdulelah S Almousa  1 , Ethar A Khawaji  2 , Abdulrahman M Almousa  3 , Mohammed A Albaqshi  3 , Ahlam S Alharbi  4
Affiliations
Case Reports

Pituitary ​​​​Apoplexy​​ With Pituitary Macroadenoma in a Patient With ​​Asymptomatic ​​​COVID-19: ​​A Case ​​​Report

Hadi S Alyami et al. Cureus. .

Abstract

Pituitary apoplexy is a rare and potentially life-threatening condition that usually occurs in the setting of a pre-existing pituitary tumor, which may be undiagnosed. There are a growing number of reports describing the pituitary apoplexy associated with coronavirus disease 2019 (COVID-19). We present the case of a 41-year-old man who presented with a gradually worsening headache for four days. It was a bilateral frontal headache of sharp quality with no radiation. He scored the headache as 9 out of 10 on the 10-point severity scale. He had no previous episodes of similar headaches. Fundoscopic examination revealed bilateral optic disc blurring suggestive of papilledema and cranial nerves examination revealed bilateral hemianopia. The patient was admitted for further investigation and management. As part of the admission protocol, the patent underwent a nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which yielded positive results. Computed tomography demonstrated a large solid intrasellar mass with areas of high density suggesting hemorrhage along with a small amount of subarachnoid hemorrhage space in the left parietal lobe. The findings were consistent with pituitary apoplexy in the setting of pituitary macroadenoma. Intravenous hydrocortisone was administered. The patient underwent transsphenoidal surgical resection of the pituitary tumor, which resulted in significant improvement in the patient's symptoms. Pituitary apoplexy is a rare condition. The case suggests that COVID-19 may predispose to the development of pituitary apoplexy.

Keywords: case report; computed tomography; covid-19; headache; magnetic resonance imaging; pituitary apoplexy; subarachnoid hemorrhage.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Sagittal (A) and coronal (B) CT images show a large intrasellar mass (arrow) with areas of high density suggestive of hemorrhage in the pituitary gland
CT: computed tomography
Figure 2
Figure 2. Axial head CT image shows subarachnoid hemorrhage (arrow) in the left parietal lobe
CT: computed tomography
Figure 3
Figure 3. Sagittal MRI T1-weighted image shows a large intrasellar mass (arrow) enlarging the sella turcica and expanding into the suprasellar cistern
MRI: magnetic resonance imaging
Figure 4
Figure 4. Coronal MRI post-contrast T1-weighted image shows a heterogeneously enhancing intrasellar mass (arrow)
MRI: magnetic resonance imaging
See this image and copyright information in PMC

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