Background Pituitary apoplexy (PA) is a rare but life-threatening condition characterized by pituitary infarction and hemorrhage, most often in the setting of a preexisting adenoma. The risk factors and mechanisms associated with PA are poorly understood. Although neurovascular manifestations of coronavirus disease-19 (COVID-19) infection have been documented, its association with PA is to be determined. Methods From a prospectively collected database of patients treated at a tertiary care center for pituitary adenoma, we conducted retrospective chart review of PA cases during the COVID-19 pandemic from March 2020 to December 2020. We also conducted a literature review to identify other reported cases. Results We identified three consecutive cases of PA and concomitant COVID-19 infection. The most common symptoms at presentation were headache and vision changes. Included patients were successfully treated with surgical decompression and medical management of associated endocrinopathy, ultimately experiencing improvement of their visual symptoms by most recent follow up. COVID-19 infection in the perioperative period was corroborated by polymerase chain reaction testing in all patients. Conclusions With the addition of our series to the literature, there are now 10 cases of confirmed PA in the setting of COVID-19 infection. This series is limited in its ability to draw conclusions about the relationship between these two entities, but COVID-19 infection may represent a risk factor for developing PA. Further studies are required.

Background. Pituitary apoplexy (PA) is a rare and potentially life-threatening condition characterized by pituitary hemorrhage, often in the setting of a preexisting pituitary adenoma. Risk factors and mechanisms associated to PA are poorly understood. Although involvement of the nervous system in SARS-CoV-2 infection causing intracranial hemorrhagic complications has been documented, the association between COVID-19 infection and PA has yet to be determined. Methods . From a prospectively collected database of patients with pituitary adenomas, we retrospectively reviewed the electronical medical records and scans of patients with pituitary apoplexy during the COVID-19 outbreak, since March 2020 to December 2020, that were treated at a tertiary care center. Results. Herein, we report three consecutive cases of patients with PA and concomitant COVID-19 infection. Most common symptom at presentation was headache and visual worsening. Included patients were successfully treated with surgical decompression and medical management of the hormonal deficits, experiencing moderate to significant improvement of their visual symptoms at last follow up. COVID-19 infection in the perioperative period was corroborated throughout polymerase chain reaction testing in all patients. Conclusions. COVID-19 positive patients may be at an increased risk of developing PA. Angiotensin-converting enzyme 2 receptors expressed in cerebrovascular endothelium may potentially play a role in the molecular mechanisms that induce changes of the vascular autoregulation and cerebral blood flow and predispose to pituitary hemorrhage in patients harboring a pituitary adenoma.