Kamel Walaa A, Najibullah Mustafa, Saleh Mamdouh S, Azab Waleed A
Department of Neurology, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait.
Department of Neurology, Beni-Suef University, Egypt.
Surg Neurol Int. 2021 Jun 28;12:317. doi: 10.25259/SNI_401_2021. eCollection 2021.
Pituitary tumor apoplexy (PA) is an emergency condition caused by hemorrhage or infarction of the preexisting adenoma. Many factors are currently well-known to predispose to PA. However, during the period of coronavirus disease 2019 (COVID-19) pandemic, case reports of PA associated with COVID-19 infection have been sequentially published. To the best of our knowledge, four cases have been reported so far in the English literature. We herein report the fifth case of this association and review the pertinent literature.
A 55-year-old male patient with confirmed COVID-19 infection presented by progressive decrease in visual acuity and oculomotor nerve palsy. His medical history is notable for diabetes mellitus, hypertension, and pituitary macroadenoma resection 11 years ago. He was on hormonal replacement therapy for panhypopituitarism that complicated the surgery. Previous magnetic resonance (MR) imaging studies were consistent with enlarging residual pituitary adenoma. During the current hospitalization, computed tomography revealed hyperdensity of the sellar and suprasellar areas. MR imaging revealed PA in a recurrent large adenoma. Endoscopic endonasal transsphenoidal resection was uneventfully undertaken with near total excision of the adenoma and partial improvement of visual loss and oculomotor palsy. Histopathological examination demonstrated classic features of PA. However, his chest condition progressed and he had to be transferred to COVID-19 intensive care unit in the referring hospital where he was intubated and put on mechanical ventilation. One week later, the patient unfortunately passed away due to complications of severe COVID-19 pneumonia.
We report the fifth case of PA associated with COVID-19 infection. Based on our patient's clinical findings, review of the other reported cases, as well as the available literature, we put forth a multitude of pathophysiological mechanisms induced by COVID-19 that can possibly lead to the development of PA. In our opinion, the association between both conditions is not just a mere coincidence. Although the histopathological features of PA associated with COVID-19 are similar to PA induced by other etiologies, future research may disclose unique pathological fingerprints of COVID-19 virus that explains its capability of inducing PA.
垂体瘤卒中（PA）是一种由先前存在的腺瘤出血或梗死引起的紧急情况。目前已知许多因素易引发PA。然而，在2019年冠状病毒病（COVID-19）大流行期间，与COVID-19感染相关的PA病例报告相继发表。据我们所知，迄今为止英文文献中已报道了4例。我们在此报告这一关联的第5例病例并回顾相关文献。
一名确诊感染COVID-19的55岁男性患者，因视力逐渐下降和动眼神经麻痹就诊。他有糖尿病、高血压病史，11年前接受过垂体大腺瘤切除术。因手术并发全垂体功能减退，他正在接受激素替代治疗。之前的磁共振（MR）成像研究显示残留垂体腺瘤增大。本次住院期间，计算机断层扫描显示鞍区和鞍上区高密度影。MR成像显示复发性大腺瘤发生PA。经鼻内镜下经蝶窦切除术顺利进行，腺瘤几乎完全切除，视力丧失和动眼神经麻痹部分改善。组织病理学检查显示PA的典型特征。然而，他的胸部病情进展，不得不转至转诊医院的COVID-19重症监护病房，在那里他接受了插管和机械通气。一周后，患者因严重COVID-19肺炎并发症不幸去世。
我们报告了第5例与COVID-19感染相关的PA病例。基于我们患者的临床发现、对其他报道病例的回顾以及现有文献，我们提出了多种由COVID-19诱导的可能导致PA发生的病理生理机制。我们认为，这两种情况之间的关联并非仅仅是巧合。尽管与COVID-19相关的PA的组织病理学特征与其他病因引起的PA相似，但未来的研究可能会揭示COVID-19病毒独特的病理特征，以解释其诱导PA的能力。
