A Novel Association Between Pituitary Tumor Apoplexy and Influenza A

Abstract

Objective: Pituitary adenomas have a population prevalence of less than 0.1%. They can rarely present with serious complications, such as pituitary tumor apoplexy with symptoms of sudden severe headache, vision impairment, nausea, and vomiting. Methods: To date, there has been no proven underlying mechanism for the development of pituitary apoplexy. We report a novel association between pituitary tumor apoplexy and influenza A, indicating an inflammatory pathology underlying influenza infection contributing to hemorrhage. Results: Our patient is a 44-year-old female with past medical history of hypertension and diabetes mellitus type 2 who presented with a 2-day history of visual deficits, progressively worsening headache, and dizziness. She reported fever, chills, myalgia, and cough and tested positive for influenza A. Magnetic resonance imaging of the brain revealed a large suprasellar macroadenoma with internal hemorrhage. She underwent emergent transsphenoidal excision of pathology-proven pituitary adenoma with apoplexy. Signs of the syndrome of inappropriate antidiuretic hormone and diabetes insipidus were frequent

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

“…Recently, Frara et al and Kamel et al showed that SARS-CoV-2 may cause pituitary apoplexy in the context of pre-existing macroadenomas (1,6). Previously, Tariq et al reported an association between influenza A infection and pituitary tumour apoplexy (4). Even though a causative link could not be demonstrated, influenza infections have been documented to increase haemorrhagic risk in multiple organs (4).…”

“…Previously, Tariq et al. reported an association between influenza A infection and pituitary tumour apoplexy ( 4 ). Even though a causative link could not be demonstrated, influenza infections have been documented to increase haemorrhagic risk in multiple organs ( 4 ).…”

“…reported an association between influenza A infection and pituitary tumour apoplexy ( 4 ). Even though a causative link could not be demonstrated, influenza infections have been documented to increase haemorrhagic risk in multiple organs ( 4 ). Other reports describe a possible relationship between viral infections (i.e., haemorrhagic fever, 2003 SARS epidemic) and direct pituitary vascular damage with ischemic and haemorrhagic signs as well as necrosis at post-mortem evaluation ( 4 – 6 ).…”

“…Risk factors for apoplexy are summarized in Table 1 ( 2 ). There are few reports of pituitary adenoma apoplexy after viral infection, such as haemorrhagic fever, 2003 Severe Acute Respiratory Syndrome (SARS) epidemic, influenza A and, recently, SARS-CoV-2 ( 1 , 2 , 4 – 6 ). Less is known on the relationship between pituitary apoplexy and SARS-CoV-2 vaccine.…”