Fatal antiphospholipid syndrome following endoscopic transnasal-transsphenoidal surgery for a pituitary tumor

Abstract

Introduction:The fatal type of antiphospholipid syndrome is a rare but life-threating condition. It may be triggered by surgery or infection. Endoscopic transnasal-transsphenoidal surgery is a common procedure for pituitary tumor. We report a catastrophic case of a young woman died of fatal antiphospholipid syndrome following endoscopic transnasal-transsphenoidal surgery.Methods and Result:A 31-year-old woman of a history of stroke received endoscopic transnasal-transsphenoidal surgery for a pituitary tumor. The whole procedure was smooth. However, the patient suffered from acute delirium on postoperative day 4. Then, her consciousness became comatose state rapidly with dilatation of pupils. Urgent magnetic resonance imaging of brain demonstrated multiple acute lacunar infarcts. The positive antiphosphoipid antibody and severe thrombocytopenia were also noted. Fatal antiphospholipid syndrome was diagnosed. Plasma exchange, corticosteroids, anticoagulant agent were prescribed. The hemodynamic condition was gradually stable. However, the consciousness was still in deep coma. The patient died of organ donation 2 months later.Conclusion:If patients have a history of cerebral stroke in their early life, such as a young stroke, the APS and higher risk of developing fatal APS after major surgery should be considered. The optimal management of APS remains controversial. The best treatment strategies are only early diagnosis and aggressive therapies combing of anticoagulant, corticosteroid, and plasma exchange. The intravenous immunoglobulin is prescribed for patients with refractory APS.

Identifying hormones and other perioperative risk factors for postoperative delirium after endoscope‐assisted transsphenoidal pituitary adenoma resection: A retrospective, matched cohort study

“…However, the association between hormone levels and delirium is still controversial. Only a few case reports have inspired us to pay close attention to hormone‐associated delirium (Burne et al., 2021 ; Li et al., 2017 ; Weng et al., 2008 ). In the present study, our data also indicate that lower IGF‐1 and CRH levels are tightly associated with postoperative delirium.…”

“…Once delirium appears in the postoperative period, it will lead to a prolonged length of stay in the NICU, increased hospitalization costs and higher mortality; therefore, it is very important to recognize and explore the risk factors for postoperative delirium in patients. To date, only a few case reports have inspired us to pay close attention to pituitary tumor‐associated delirium (Burne et al., 2021 ; Li et al., 2017 ; Weng et al., 2008 ). Even idiopathic pituitary insufficiency could present as prolonged delirium and a “terrible dream” (McAulay‐Powell & Friedman, 2013 ).…”