Department of Endocrinology, Diabetes Mellitus and Nutrition.
Department of Neurosurgery, Amiens University Hospital, Amiens, France.
Eur J Endocrinol. 2022 Jul 19;187(3):K19-K25. doi: 10.1530/EJE-22-0056. Print 2022 Sep 1.
Since the outbreak of the COVID-19 pandemic, several cases of pituitary apoplexy (PA) following a SARS-CoV-2 infection have been described in several countries. Here, we describe a case series of PA occurring in the aftermath of a SARS-CoV-2 infection to alert physicians about possible neuro-endocrinological damage caused by the virus that can lead to visual sequelae and hypopituitarism.
We retrospectively identified all the adult patients treated at Amiens University Hospital between March 2020 and May 2021 for PA confirmed by cerebral imaging and following an RT-PCR-confirmed SARS-CoV-2 infection.
Eight cases (six women, two men) occurred between March 2020 and May 2021 and were reviewed in this study. The mean age at diagnosis was 67.5 ± 9.8 years. Only one patient had a 'known' non-functional pituitary macroadenoma. The most common symptom of PA was a sudden headache. Brain imaging was typical in all cases. Only two patients required decompression surgery, whereas the others were managed conservatively. The clinical outcome was favorable for all patients but without recovery of their pituitary deficiencies. There was no diabetes insipidus.
This case series, the largest in the literature, reinforces the strength, consistency, and coherence of the association between SARS-CoV-2 infection and PA. Our study provides support for the hypothesis that SARS-CoV-2 may be a new precipitating factor for PA. It is essential that practitioners be alerted about possible pituitary disease due to the virus so that such patients are recognized and appropriately managed, hence improving their prognosis.
自 COVID-19 大流行爆发以来，在多个国家已有数例垂体卒中（PA）继发于 SARS-CoV-2 感染的病例报道。在此，我们描述了一系列继发于 SARS-CoV-2 感染的 PA 病例，以提醒医生注意病毒可能导致的神经内分泌损害，从而导致视觉后遗症和垂体功能减退。
我们回顾性地确定了 2020 年 3 月至 2021 年 5 月期间在亚眠大学医院治疗的所有成年患者，这些患者通过脑成像证实为 PA，且继发于 RT-PCR 确诊的 SARS-CoV-2 感染。
8 例（6 名女性，2 名男性）患者发生于 2020 年 3 月至 2021 年 5 月期间，本研究对其进行了回顾性分析。诊断时的平均年龄为 67.5±9.8 岁。仅有 1 例患者存在“已知”无功能垂体大腺瘤。PA 最常见的症状是突发头痛。所有病例的脑部影像学检查均具有典型表现。仅 2 例患者需要减压手术，而其他患者则接受了保守治疗。所有患者的临床结局均良好，但垂体功能减退未得到恢复。无尿崩症。
本病例系列为文献中最大的系列，进一步证实了 SARS-CoV-2 感染与 PA 之间的关联具有较强的一致性和连贯性。我们的研究支持了 SARS-CoV-2 可能是 PA 的新诱发因素这一假说。提醒医生注意病毒可能导致的垂体疾病非常重要，以便及时识别此类患者并进行适当治疗，从而改善其预后。
