Pituitary Apoplexy Following Elective Total Hip Replacement

Abstract

Pituitary apoplexy is an endocrine-related emergency most commonly caused by hemorrhage into a preexisting pituitary adenoma. Known risk factors for such hemorrhage include major surgical procedures, head trauma, pregnancy, anticoagulation, and the administration of hormone therapies for the correction of primary hypothalamic deficiencies. Elective orthopedic surgery is an uncommon precipitator of pituitary apoplexy that is rarely described. We report the case of a patient with a previously unknown pituitary macroadenoma who developed apoplexy as a complication of elective right total hip arthroplasty.

Keywords: nonfunctioning pituitary adenoma; pituitary apoplexy; pituitary macroadenoma; total hip arthroplasty; transsphenoidal resection.

Figure 1. CT head taken after the initial development of new neurological findings on physical exam. The arrow highlights a heterogeneous soft tissue mass displaying characteristics consistent with pituitary macroadenoma.

CT: computed tomography

Figure 2. Sagittal cut of MRI brain DWI-FLAIR, which shows pituitary macroadenoma that measures 30.46 millimeters at its longest angle.

MRI: magnetic resonance imaging; DWI-FLAIR: diffusion-weighted imaging and fluid-attenuated inversion recovery

Figure 3. CT head was taken after transsphenoidal resection of the pituitary mass. The arrow shows the interval removal of pituitary mass with no unexpected post-operative changes.

CT: computed tomography