Pituitary apoplexy in the setting of COVID-19 infection

LaRoy, Michael; McGuire, Morgan

doi:10.1016/j.ajem.2021.02.045

Cited by 22 publications

(15 citation statements)

References 12 publications

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“…Hemorrhagic pituitary microadenoma consistent with pituitary apoplexy was found at MRI. No abnormal hormonal data were found and patient was discharged and kept on follow up [64].…”

Section: Pituitary Apoplexymentioning

confidence: 98%

“…Moreover, the virus has been hypothesized to enter the brain through the nasopharyngeal epithelium via the olfactory nerve, or could pass through the blood-brain barrier or directly reach the median eminence, a circumventricular organ where the blood-brain barrier is lacking [59]. In fact, recently, several cases of pituitary apoplexy associated with COVID-19 mainly in the context of pre-existing macroadenomas were reported (Table 1) [60][61][62][63][64][65].…”

Section: Pituitary Apoplexymentioning

confidence: 99%

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COVID-19 and the pituitary

et al. 2021

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Background Despite COVID-19 being identified as severe respiratory viral infection, progressively many relevant endocrine manifestations have been reported greatly contributing to the severity of the clinical presentation. Systemic involvement in COVID-19 is due to the ubiquitous expression of angiotensin-converting enzyme 2 (ACE2) receptor, responsible for the entry in the cells of SARS-CoV-2, Several reports in humans and animal models showed a significant ACE2 mRNA expression in hypothalamus and pituitary cells. Moreover, higher mortality and poorer outcomes have been widely described in COVID-19 patients with obesity, diabetes and vertebral fractures, which are all highly prevalent in subjects with pituitary dysfunctions. Aim To review the main endocrine manifestations of COVID-19 with their possible implications for pituitary diseases, the possible direct and indirect involvement of the pituitary gland in COVID-19, the impact of COVID-19 on the management of established pituitary diseases which can be already at increased risk for worse outcomes and on neurosurgical activities as well as vaccination. Conclusions Our review underlines that there could be a specific involvement of the pituitary gland which fits into a progressively shaping endocrine phenotype of COVID-19. Moreover, the care for pituitary diseases need to continue despite the restrictions due to the emergency. Several pituitary diseases, such as hypopituitarism and Cushing disease, or due to frequent comorbidities such as diabetes may be a risk factor for severe COVID-19 in affected patients. There is the urgent need to collect in international multicentric efforts data on all these aspects of the pituitary involvement in the pandemic in order to issue evidence driven recommendations for the management of pituitary patients in the persistent COVID-19 emergency.

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“…Hemorrhagic pituitary microadenoma consistent with pituitary apoplexy was found at MRI. No abnormal hormonal data were found and patient was discharged and kept on follow up [64].…”

Section: Pituitary Apoplexymentioning

confidence: 98%

Section: Pituitary Apoplexymentioning

confidence: 99%

COVID-19 and the pituitary

et al. 2021

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“…Ein thromboembolisches Ereignis kann auch die Erstmanifestation einer COVID-19 Erkrankung in der Schwangerschaft darstellen [265][266][267]. Fallberichte von Sinusvenenthrombose und Hypophysenapoplex wurden dokumentiert [268,269]. In Abwesenheit evidenzbasierter Therapieregime zur VTE-Prophylaxe bei SARS-CoV-2-Infektion/COVID-19 für Schwangerschaft, Geburt und Wochenbett kann zur Therapieinitiierung und -planung die S3-Leitlinie Empfehlungen zur stationären Therapie von Patienten mit COVID-19 (AWMF-Register-Nr.…”

Section: Thombembolierisikounclassified

“…Ein thromboembolisches Ereignis kann auch die Erstmanifestation einer COVID-19 Erkrankung in der Schwangerschaft darstellen 265 266 267 . Fallberichte von Sinusvenenthrombose und Hypophysenapoplex wurden dokumentiert 268 269 .…”

Section: Hintergrundinformationen Zu Sars-cov-2 Und Covid-19 In Der S...unclassified

Empfehlungen zu SARS-CoV-2/COVID-19 in Schwangerschaft, Geburt und Wochenbett – Update November 2021 (Langfassung)

Zöllkau

Hagenbeck

Hecher

et al. 2021

Z Geburtshilfe Neonatol

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ZusammenfassungSeit Beginn der SARS-CoV-2-Pandemie haben die Deutsche Gesellschaft für Gynäkologie und Geburtshilfe und die Gesellschaft für Peri-/Neonatalmedizin Empfehlungen zum Umgang mit SARS-CoV-2-positiven Schwangerschaften und Neugeborenen veröffentlicht und wiederholt aktualisiert. Als Weiterführung der bestehenden Empfehlungen werden in dem aktuellen Update Schlüsselfragen zur prä-, peri- und postnatalen Versorgung von Schwangeren, Gebärenden, Wöchnerinnen, Stillenden mit SARS-CoV-2 und COVID-19 sowie deren Un- oder Neugeborenen auf der Grundlage von Veröffentlichungen bis zum September 2021 behandelt. Die Empfehlungen und Stellungnahmen wurden sorgfältig aus den aktuell verfügbaren wissenschaftlichen Daten abgeleitet und anschließend im Expertenkonsens verabschiedet. Dieser Leitfaden – hier in der Langfassung vorliegend – soll eine Hilfe für die klinische Entscheidungsfindung darstellen. Die Auslegung und therapeutische Verantwortung obliegen weiterhin dem betreuenden medizinischen Team vor Ort, dessen Entscheidungen durch diese Empfehlungen unterstützt werden sollen. Aufgrund der raschen Dynamik neuer Erkenntnisse kann eine Anpassung erforderlich sein. Die Empfehlungen werden durch die Zustimmung der Fachgesellschaften getragen: Deutsche Gesellschaft für Perinatale Medizin (DGPM), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Deutsche Gesellschaft für Pränatal- und Geburtsmedizin (DGPGM), Deutsche Gesellschaft für Pädiatrische Infektiologie (DGPI), Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin (GNPI).

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“…Apart from the involvement of the pituitary-thyroid and pituitary-adrenal axis by COVID-19, as discussed above, several case reports of pituitary apoplexy within pituitary adenomas in patients with COVID-19 have come to light. [ 21 22 23 ] In one case, apoplexy appeared to occur in the absence of a pituitary adenoma or other risk factors, raising the possibility of COVID-19 itself being the cause. [ 24 25 ] Hyperprolactinemia has been reported in COVID-19 patients.…”

mentioning

confidence: 99%