2000 Associates' Presentations
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The Unmasking of an Asymptomatic Pituitary Tumor Following Antithrombotic Therapy
Todd J. Kowalski, Gundersen Lutheran Medical Center, LaCrosse, WI
Pituitary apoplexy is the relatively rare and potentially life threatening infarction of the pituitary gland. It usually occurs in the presence of pituitary tumor, after obstetric hemorrhage, in the setting of increased intracranial pressure, or following anticoagulation. Prompt recognition and appropriate management of pituitary apoplexy can minimize neurological sequelae, and may be life saving. This may be especially pertinent in relatively high-risks settings, such as cardiac care units where intense antithrombotic and thrombolytic therapies are used. The induction of pituitary apoplexy following anticoagulation or thrombolytic therapy has been preciously reported. We report another case of hemorrhage into an unbeknownst pituitary tumor following antithrombotic therapy.
A 48-year-old white female was transferred from a local hospital with a 5-day history of atypical chest pain, nausea, vomiting and elevated cardiac enzymes. She was diagnosed with amycaridal infarction and underwent cardiac catheterization with angioplasty and stent placement to her circumflex artery. On hospital day number three the patient had an episode of polymorphic ventricular tachycardia that required electrocardioversion, and subsequently heparin was added to her antithrombotic regimen of aspirin and clopidogrel. Later that day the patient complained of headache, photophobia, and diplopia, and physical examination revealed a new right-sided cranial nerve VI palsy. Unenhanced head CT was suspicious for sellar mass. MRI could not be performed due to her recent coronary artery stent procedure. Endocrine studies for pituitary dysfunction were normal. On hospital day number six she progressed to complete right-sided ophthalmoplegia with ptosis, and the following day she developed left-sided cranial nerve VI palsy. The patient emergently underwent trans-sphenoidal resection of the suspected pituitary mass. Pathologic examination revealed a nonfunctioning pituitary adenoma with apoplexy.
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Kelly Lang
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