A Rare Case of SARS-CoV-2 Infection Associated With Pituitary Apoplexy Without Comorbidities

Ghosh, Ritwik; Roy, Dipayan; Roy, Devlina; Mandal, Arpan; Dutta, Aloke K.; Naga, Dinabandhu; Benito‐León, Julián

doi:10.1210/jendso/bvaa203

Cited by 33 publications

(31 citation statements)

References 21 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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“…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%

“…Ghosh et al reported a case of a 44-year-old woman admitted to the ED with complaints of a sudden-onset severe headache and progressive asymmetric visual blurriness, symptoms preceded by abrupt-onset intermittent fever [61]. Cognitive and cranial nerve functions were intact except for subtly asymmetric bitemporal hemianopic visual field defects.…”

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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“…A more recent case of a 44-year-old healthy woman with undiagnosed pituitary macroadenoma, presenting with concomitant COVID-19 infection requiring hospitalisation and pituitary apoplexy has been published. 9 Again, the authors draw on both the physical location of COVID-19 infection giving advantage to CNS infection, as well as likely endothelial dysfunction, platelet derangement, coagulopathy and the understood fragility of the pituitary vasculature as possible explanations for this clinical scenario.…”

Section: Discussionmentioning

confidence: 99%

Apoplexy in a previously undiagnosed pituitary macroadenoma in the setting of recent COVID-19 infection

et al. 2021

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Pituitary apoplexy is an endocrine emergency, which commonly presents as hypopituitarism. Prompt diagnosis and treatment can be both life and vision saving. There are a growing number of published case reports postulating a link between COVID-19 and pituitary apoplexy. We report the case of a 75-year-old man who presented with a headache and was later diagnosed with hypopituitarism secondary to pituitary apoplexy. This occurred 1 month following a mild-to-moderate COVID-19 infection with no other risk factors commonly associated with pituitary apoplexy. This case, therefore, supplements an emerging evidence base supporting a link between COVID-19 and pituitary apoplexy.

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A Rare Case of SARS-CoV-2 Infection Associated With Pituitary Apoplexy Without Comorbidities

Cited by 33 publications

References 21 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

Apoplexy in a previously undiagnosed pituitary macroadenoma in the setting of recent COVID-19 infection

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