Pituitary apoplexy associated with acute COVID-19 infection and pregnancy
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Pituitary apoplexy associated with acute COVID‑19 infection and pregnancy Julie L. Chan1 · Kimberly D. Gregory2 · Sarah S. Smithson2 · Mariam Naqvi2 · Adam N. Mamelak1 Accepted: 29 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose We report a case of a pregnant female presenting with pituitary apoplexy and simultaneous SARS-CoV-2 infection with a focus on management decisions. Clinical history A 28-year-old G5P1 38w1d female presented with 4 days of blurry vision, left dilated pupil, and headache. She tested positive for SARS-CoV-2 on routine nasal swab testing but denied cough or fever. Endocrine testing demonstrated an elevated serum prolactin level, and central hypothyroidism. MRI showed a cystic-solid lesion with a fluid level in the pituitary fossa and expansion of the sella consistent with pituitary apoplexy. Her visual symptoms improved with corticosteroid administration and surgery was delayed to two weeks after her initial COVID-19 infection and to allow for safe delivery of the child. A vaginal delivery under epidural anesthetic occurred at 39 weeks. Two days later, transsphenoidal resection of the mass was performed under strict COVID-19 precautions including use of Powered Air Purifying Respirators (PAPRs) and limited OR personnel given high risk of infection during endonasal procedures. Pathology demonstrated a liquefied hemorrhagic mass suggestive of pituitary apoplexy. She made a full recovery and was discharged home two days after surgery. Conclusion Here we demonstrate the first known case of successful elective induction of vaginal delivery and transsphenoidal intervention in a near full term gravid patient presenting with pituitary apoplexy and acute SARS-CoV-2 infection. Further reports may help determine if there is a causal relationship or if these events are unrelated. Close adherence to guidelines for caregivers can greatly reduce risk of infection. Keywords Pituitary apoplexy · COVID-19 · Coronavirus · SARS-CoV-2 · Pregnancy
Introduction Pituitary apoplexy (PA) is defined as the sudden hemorrhagic infarction of a pre-existing pituitary tumor, or in rare cases the gland itself. Typical symptoms of apoplexy include sudden onset of headache, visual loss, diplopia, nausea, fatigue, and hormonal deficiencies. The management of pituitary apoplexy is still somewhat debated. Patients with rapidly expanding mass lesions and severe or progressive visual loss or altered level of consciousness are typically operated on urgently to decompress the mass. Primary medical management often includes the use of corticosteroids * Adam N. Mamelak [email protected] 1
Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Cedars‑Sinai Medical Center, Maternal Fetal Medicine, Los Angeles, CA, USA
2
both to reduce edema of the ocular motor and optic nerves as well as to prevent symptoms of adrenal insufficiency due to loss of adrenocorticotrophic hormone (ACTH) secretion by the compressed or infarcted gland. PA is relatively
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