Pituitary tumor resection in a patient with SARS-CoV-2 (COVID-19) infection. A case report and suggested airway management guidelines

Santos, Christiano Dos Santos E; Filho, L Moreira; Santos, Cristiane Araujo Tuma; Neill, James S.; Vale, Henrique; Kurnutala, Lakshmi N

doi:10.1016/j.bjane.2020.05.003

Cited by 14 publications

(12 citation statements)

References 12 publications

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“…To the best of our knowledge, four cases have been reported so far in the English literature. [ 8 , 10 , 19 , 21 ] We herein report the fifth case of this association. Although the available information is limited, analyzing the pertinent literature is important to gain further insight on whether the PA is directly caused by COVID-19 infection and to come up with plausible pathophysiological mechanism(s) if any.…”

Section: Introductionmentioning

confidence: 91%

Coronavirus disease 2019 infection and pituitary apoplexy: A causal relation or just a coincidence? A case report and review of the literature

Kamel

Najibullah

Saleh

et al. 2021

Surgical Neurology International

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Background: Pituitary tumor apoplexy (PA) is an emergency condition caused by hemorrhage or infarction of the preexisting adenoma. Many factors are currently well-known to predispose to PA. However, during the period of coronavirus disease 2019 (COVID-19) pandemic, case reports of PA associated with COVID-19 infection have been sequentially published. To the best of our knowledge, four cases have been reported so far in the English literature. We herein report the fifth case of this association and review the pertinent literature. Case Description: A 55-year-old male patient with confirmed COVID-19 infection presented by progressive decrease in visual acuity and oculomotor nerve palsy. His medical history is notable for diabetes mellitus, hypertension, and pituitary macroadenoma resection 11 years ago. He was on hormonal replacement therapy for panhypopituitarism that complicated the surgery. Previous magnetic resonance (MR) imaging studies were consistent with enlarging residual pituitary adenoma. During the current hospitalization, computed tomography revealed hyperdensity of the sellar and suprasellar areas. MR imaging revealed PA in a recurrent large adenoma. Endoscopic endonasal transsphenoidal resection was uneventfully undertaken with near total excision of the adenoma and partial improvement of visual loss and oculomotor palsy. Histopathological examination demonstrated classic features of PA. However, his chest condition progressed and he had to be transferred to COVID-19 intensive care unit in the referring hospital where he was intubated and put on mechanical ventilation. One week later, the patient unfortunately passed away due to complications of severe COVID-19 pneumonia. Conclusion: We report the fifth case of PA associated with COVID-19 infection. Based on our patient’s clinical findings, review of the other reported cases, as well as the available literature, we put forth a multitude of pathophysiological mechanisms induced by COVID-19 that can possibly lead to the development of PA. In our opinion, the association between both conditions is not just a mere coincidence. Although the histopathological features of PA associated with COVID-19 are similar to PA induced by other etiologies, future research may disclose unique pathological fingerprints of COVID-19 virus that explains its capability of inducing PA.

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Section: Introductionmentioning

confidence: 91%

Coronavirus disease 2019 infection and pituitary apoplexy: A causal relation or just a coincidence? A case report and review of the literature

Kamel

Najibullah

Saleh

et al. 2021

Surgical Neurology International

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“…The patient complained of worsening left visual acuity with no improvement of headache and neurosurgeons decided to schedule him for an urgent TNS tumor resection. He was discharged from the hospital four days later without any complication [ 62 ].…”

Section: Main Pituitary Manifestations Of Covid-19mentioning

confidence: 99%

“…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%

“…The patient tested positive for SARS-CoV-2 had sudden worsening of the respiratory function, with severe hypoxemia refractory to invasive mechanical ventilation, and died 12 h after hospital admission [63]. Santos et al described a 47-year-old male patient who presented to the emergency department (ED) with a left frontal headache that began 5 days before, followed by diplopia, left eye ptosis, and visual loss in left eye [62]. A head CT scan showed a predominantly hyperdense sellar mass (19 × 28 × 20 mm) eccentric to the left with extension into the suprasellar cistern impinging on the left optic chiasm, consistent with pituitary macroadenoma with central hemorrhage.…”

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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“…Although use of high-dose narcotic analgesics such as morphine and fentanyl have been observed to cause immune suppression, they are safe, economic, and effective for the management of severe cancer pain when used by medical advice and with precautions [19][20][21]. Recent studies suggest that narcotic compounds such as fentanyl and lidocaine can minimize aerosolization risk of coughing during extubation [22][23][24][25][26][27]. In China, a preliminary analysis in a case study report, examined data from 5 case series of hospitalized COVID-19 patients, and calculated a smoking prevalence of 10.2 % (95 % CI: 8.7-11.8 %) while the estimated expected prevalence was 31.3 % (95 % CI: 8.7-11.8 %) [28].…”

Section: Introductionmentioning

confidence: 99%

Blocking SARS-CoV-2 Spike Protein binding to ACE2 receptor through Narcotinic Compounds Combined with Adjuvants: an in silico Insight

Mohammadi¹,

Esmailpour

Sakhaee

et al. 2021

Preprint

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Protein products of SARS-CoV-2 spike (S) coding gene sequence, were all analyzed and compared to other SARS-CoV S proteins to elucidate structural similarities of spike proteins. A homology modeling of SARS-CoV-2 S protein was obtained and used in molecular docking studies to find binding affinities of spike protein for angiotensin-converting enzyme 2 (ACE2). The two most important binding sites of S protein, namely, RBD and CTD, critically responsible for binding interactions, were identified. Finally, binding affinity of RBD and CTD domains of S protein with narcotic analgesics are studied. Moreover, interactions of ACE2 receptor- S protein with narcotic compounds when mixed with small molecule adjuvants to improve the immune response and increase the efficacy of potential vaccines, were taken into consideration. In-silico results suggest that the combination of narcotine hemiacetal with mannide monooleate shows a stronger binding affinity with CTD, while carprofen-muramyl dipeptide and squalene have stronger binding affinities for the RBD portion of S protein. Thus, a suitable combination of these narcotic is proposed to yield potent site-blocking efficacy for ACE2 receptor against SARS-CoV-2 spike proteins.

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Pituitary tumor resection in a patient with SARS-CoV-2 (COVID-19) infection. A case report and suggested airway management guidelines

Cited by 14 publications

References 12 publications

Coronavirus disease 2019 infection and pituitary apoplexy: A causal relation or just a coincidence? A case report and review of the literature

Coronavirus disease 2019 infection and pituitary apoplexy: A causal relation or just a coincidence? A case report and review of the literature

COVID-19 and the pituitary

Blocking SARS-CoV-2 Spike Protein binding to ACE2 receptor through Narcotinic Compounds Combined with Adjuvants: an in silico Insight

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