Pituitary apoplexy associated with COVID-19 infection: review and a case report

Popov, Deyan; Hadzhiyanev, Asen

doi:10.1080/13102818.2022.2051738

Cited by 4 publications

(2 citation statements)

References 20 publications

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“…The SARS-CoV-2 virus causes a complex infectious disease with a diverse clinical presentation and complications [ 1 ]. Identifying possible consequences of the said viral infection had been challenging throughout due to its multisystemic involvement.…”

Section: Discussionmentioning

confidence: 99%

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Pituitary Apoplexy as a Complication of COVID-19 Infection

Hussain¹,

Janaka²,

Muthukuda³

et al. 2023

Cureus

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Pituitary apoplexy (PA) is a complication occurring due to hemorrhage and/or infarction in a pituitary adenoma due to various pathophysiological mechanisms. Herein, we report a case of a 47-year-old previously healthy male who presented with fever and reduced level of consciousness for one day. During the hospital stay, he was diagnosed with PA in a background of pituitary macroadenoma along with positive nasopharyngeal swabs for SARS-CoV-2 infection. Even though the PA was successfully managed, the patient succumbed four days after admission due to respiratory failure caused by severe COVID-19 pneumonia.

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Section: Discussionmentioning

confidence: 99%

“…Even though respiratory pathology is the hallmark of COVID-19, it can also cause numerous extrapulmonary manifestations [ 1 ]. Pituitary apoplexy (PA) is a rare life-threatening extrapulmonary manifestation, reported in patients with COVID-19 infection and pituitary adenoma [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Pituitary Apoplexy as a Complication of COVID-19 Infection

Hussain¹,

Janaka²,

Muthukuda³

et al. 2023

Cureus

View full text Add to dashboard Cite

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COVID19 infection and vaccination and the risk of pituitary apoplexy: an entangled yarn

Ragni,

Biamonte,

Cavigiolo

et al. 2024

Endocrine

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Pituitary apoplexy and COVID-19 vaccination: a case report and literature review

et al. 2022

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A 50-year-old man was admitted to our hospital for vomit, nausea, diplopia, and headache resistant to analgesic drugs. Symptoms started the day after his third COVID-19 mRNA vaccine (Moderna) whereas SARS-CoV-2 nasal swab was negative. Pituitary MRI showed recent bleeding in macroadenoma, consistent with pituitary apoplexy. Adverse Drug Reaction was reported to AIFA (Italian Medicines Agency).A stress dexamethasone dose was administered due to the risk of adrenal insufficiency and to reduce oedema. Biochemistry showed secondary hypogonadism; inflammatory markers were elevated as well as white blood cells count, fibrinogen and D-dimer. Pituitary tumour transsphenoidal resection was performed and pathology report was consistent with pituitary adenoma with focal haemorrhage and necrosis; we found immunohistochemical evidence for SARS-CoV-2 proteins next to pituitary capillaries, in the presence of an evident lymphocyte infiltrate.Few cases of pituitary apoplexy after COVID-19 vaccination and infection have been reported. Several hypotheses have been suggested to explain this clinical picture, including cross-reactivity between SARS-CoV-2 and pituitary proteins, COVID-19-associated coagulopathy, infection-driven acutely increased pituitary blood demand, anti-Platelet Factor 4/heparin antibodies development after vaccine administration. Ours is the first case of SARS-CoV-2 evidence in pituitary tissue, suggesting that endothelial infection of pituitary capillaries could be present before vaccination, possibly due to a previous asymptomatic SARS-CoV-2 infection. Our case underlines that SARS-CoV-2 can associate with apoplexy by penetrating the central nervous system, even in cases of negative nasal swab. Patients with pituitary tumours may develop pituitary apoplexy after exposure to SARS-CoV-2, therefore clinicians should be aware of this risk.

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Pituitary apoplexy associated with COVID-19 infection: review and a case report

Cited by 4 publications

References 20 publications

Pituitary Apoplexy as a Complication of COVID-19 Infection

Pituitary Apoplexy as a Complication of COVID-19 Infection

COVID19 infection and vaccination and the risk of pituitary apoplexy: an entangled yarn

Pituitary apoplexy and COVID-19 vaccination: a case report and literature review

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