Rapidly Progressive Pituitary Apoplexy in a Patient with COVID-19 Disease Treated with Endoscopic Endonasal Surgery

Abstract

This report describes a case of pituitary apoplexy with rapidly evolving hemorrhage in a 74-year-old female with coronavirus disease 2019 (COVID-19) disease. The patient presented with severe headache and mild respiratory symptoms, with laboratories concerning for pituitary hypofunction. Brain imaging demonstrated a sellar mass concerning for a pituitary adenoma with ischemic apoplexy. She subsequently developed visual deficits within 24 hours of presentation, and repeat imaging demonstrated evolving hemorrhage and new mass effect on the optic chiasm. She was successfully managed with urgent endoscopic endonasal surgery despite her COVID-19 positive status by taking special intraoperative precautions to mitigate SARS-CoV2 transmission risk. Only a handful of cases of pituitary apoplexy have been reported in association with COVID-19 disease, and even fewer reports exist of endonasal procedures in such cases. We discuss the potential implication of COVID-19 in the occurrence of pituitary apoplexy, in addition to the safety and success of endonasal surgery in this population.

Keywords

pituitary apoplexy - COVID-19 - endonasal surgery

Availability of Data and Material

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Code Availability

Not applicable.

Publikationsverlauf

Eingereicht: 04. Februar 2021

Angenommen: 20. September 2021

Artikel online veröffentlicht:
10. Januar 2022

• References

• 1 Singh TD, Valizadeh N, Meyer FB, Atkinson JL, Erickson D, Rabinstein AA. Management and outcomes of pituitary apoplexy. J Neurosurg 2015; 122 (06) 1450-1457
• 2 Wildemberg LE, Glezer A, Bronstein MD, Gadelha MR. Apoplexy in nonfunctioning pituitary adenomas. Pituitary 2018; 21 (02) 138-144
• 3 Briet C, Salenave S, Bonneville J-F, Laws ER, Chanson P. Pituitary Apoplexy. Endocr Rev 2015; 36 (06) 622-645
• 4 Tan SK, Seow CJ, Tan E, Chau YP, Dalan R. Pituitary apoplexy secondary to thrombocytopenia due to dengue hemorrhagic fever: a case report and review of the literature. Endocr Pract 2014; 20 (04) e58-e64
• 5 Capatina C, Inder W, Karavitaki N, Wass JA. Management of endocrine disease: pituitary tumour apoplexy. Eur J Endocrinol 2015; 172 (05) R179-R190
• 6 Siddiqi HK, Libby P, Ridker PM. COVID-19–a vascular disease. Trends Cardiovasc Med 2021; 31 (01) 1-5
• 7 Li Y, Li M, Wang M. et al. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke Vasc Neurol 2020; 5 (03) 279-284
• 8 Shahjouei S, Naderi S, Li J. et al. Risk of stroke in hospitalized SARS-CoV-2 infected patients: a multinational study. EBioMedicine 2020; 59: 102939
• 9 Mazzeffi MA, Chow JH, Tanaka K. COVID-19 associated hypercoagulability: manifestations, mechanisms, and management. Shock 2021; 55 (04) 465-471
• 10 Kichloo A, Dettloff K, Aljadah M. et al. COVID-19 and hypercoagulability: a review. Clin Appl Thromb Hemost 2020; 26: 1076029620962853
• 11 Frara S, Allora A, Castellino L, di Filippo L, Loli P, Giustina A. COVID-19 and the pituitary. Pituitary 2021; 24 (03) 465-481
• 12 Chigr F, Merzouki M, Najimi M. Autonomic brain centers and pathophysiology of COVID-19. ACS Chem Neurosci 2020; 11 (11) 1520-1522
• 13 Chan JL, Gregory KD, Smithson SS, Naqvi M, Mamelak AN. Pituitary apoplexy associated with acute COVID-19 infection and pregnancy. Pituitary 2020; 23 (06) 716-720
• 14 Solorio-Pineda S, Almendárez-Sánchez CA, Tafur-Grandett AA. et al. Pituitary macroadenoma apoplexy in a severe acute respiratory syndrome-coronavirus-2-positive testing: causal or casual?. Surg Neurol Int 2020; 11: 304
• 15 Ghosh R, Roy D, Roy D. et al. A rare case of SARS-CoV-2 infection associated with pituitary apoplexy without comorbidities. J Endocr Soc 2021; 5 (03) a203
• 16 e Santos CdS, da Costa Lima Filho LM, Santos CAT, Neill JS, Vale HF, Kurnutala LN. Pituitary tumor resection in a patient with SARS-CoV-2 (COVID-19) infection. A case report and suggested airway management guidelines. Braz J Anesthesiol 2020; 70 (02) 165-170
• 17 Fleseriu M, Buchfelder M, Cetas JS. et al. Pituitary society guidance: pituitary disease management and patient care recommendations during the COVID-19 pandemic-an international perspective. Pituitary 2020; 23 (04) 327-337
• 18 Workman AD, Welling DB, Carter BS. et al. Endonasal instrumentation and aerosolization risk in the era of COVID-19: simulation, literature review, and proposed mitigation strategies. Int Forum Allergy Rhinol 2020; 10 (07) 798-805
• 19 Snyderman CH, Gardner PA. Endonasal drilling may be employed safely in the COVID-19 era. Int Forum Allergy Rhinol 2020; 10 (09) 1118-1119
• 20 Workman AD, Xiao R, Feng A. et al. Suction mitigation of airborne particulate generated during sinonasal drilling and cautery. Int Forum Allergy Rhinol 2020; 10 (10) 1136-1140
• 21 Dharmarajan H, Freiser ME, Sim E. et al. Droplet and aerosol generation with endonasal surgery: methods to mitigate risk during the COVID-19 pandemic. Otolaryngol Head Neck Surg 2021; 164 (02) 285-295
• 22 Velasquez N, Ahmed OH, Lavigne P. et al. Utility of nasal access guides in endoscopic endonasal skull base surgery: assessment of use during cadaveric dissection and workflow analysis in surgery. J Neurol Surg B Skull Base 2021; 82 (05) 540-546