Pituitary Apoplexy With Transition to Acute Hypophysitis in a Patient With Sars-CoV-2 Pneumonia

Abstract

COVID-19 is a systemic disease associated with respiratory insufficiency, systemic inflammation, as well as coagulation, neurological, and endocrine disorders. Among them pituitary apoplexy (PA) as well as, more rarely, acute hypophysitis (AH) have been reported. In the present report, we described a case of PA in an 84-year-old man with SARS-CoV-2 pneumonia, with a previous unknown pituitary adenoma and a possible but not confirmed overlap with transitory AH. After reviewing the available literature, we discuss the potential clinical and pathophysiological relationship between PA and AH. Furthermore, we focus on the neuroradiological features of pituitary lesions in the presence of SARS-CoV-2 infection.

Keywords: COVID-19; SARS-CoV-2 pneumonia; hypophysitis; pituitary; pituitary apoplexy.

Figure 1.

The first magnetic resonance imaging examination confirmed a sellar and suprasellar mass iso-hyperintense to the brain tissue on T1 and T2 weighted images with an hypointense area on T2*Fast Field Echo images as hemosyderin component (black arrow) in possible subacute bleeding. After intravenous injection of gadolinium, an evident ring sign, thickening of the pituitary stalk, and infundibulum and dural tail sign (red arrow) have been detected; an evident sphenoidal mucosal thickening is also present.

Figure 2.

The second magnetic resonance imaging examination revealed a partial improvement with an initial reduction of the thickening of the pituitary stalk (green arrow), infundibulum, and the dura mater; the parasellar T2 dark sign does not appear, and the variation of the intralesional signal in T1 and T2 weighted images is depicted in the basal sequences.

Figure 3.

The last magnetic resonance imaging examination reported a morphological pattern that was partially normalized if compared to the first examination. In particular, a global reduction of the glandular size, a normal infundibulum and pituitary stalk enhancement, and a normal morphology of the cavernous sinuses were apparent while the persistence of absent spontaneous signal hyperintensity in T1 of the neurohypophysis together with a prevalent intraglandular signal cystic fluid with areas of low signal in T2* due to hemosiderin in previous intraglandular bleeding (pituitary apoplexy) were still present.