Pituitary macroadenoma apoplexy in a severe acute respiratory syndrome-coronavirus-2-positive testing: Causal or casual?

Abstract

Background: In December 2019, in Wuhan, a new virus emerged, causing severe acute respiratory syndrome (SARS) secondary to infection by a type of coronavirus, causing coronavirus disease (COVID-19). The pandemic caused by the new coronavirus has had implications in the central nervous system. COVID-19 is known to be characterized by coagulation activation and endothelial dysfunction, causing ischemic and hemorrhagic vascular syndromes. Case Description: A 27-year-old male patient case with progressive decrease in visual acuity, associated with respiratory symptoms and intense headache. Multilobar infiltrate with a reticulonodular pattern is evident on chest CT scan. Brain CT scan with pituitary macroadenoma apoplexy was shown. SARS-Cov2 was confirmed, and respiratory support initiated. However, the patient died shortly afterward, secondary to pulmonary complications. Conclusion: The angiotensin-converting enzyme (ACE) II receptor is expressed in circumventricular organs and in cerebrovascular endothelial cells, which play a role in vascular autoregulation and cerebral blood flow. For this reason, is rational the hypothesize that brain ACE II could be involved in COVID-19 infection. Underlying mechanisms require further elucidation in the future.

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

“…Chan et al [ 5 ] have recently reported a case of pituitary apoplexy associated with a third-trimester pregnancy complicated by infectious coronavirus disease 2019 (COVID-19). A few other cases [ 6-8 ] have also been reported thus far ( Table 1 ). However, in none of these cases [ 5-8 ] have the authors suggested a causal relationship between pituitary apoplexy and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.…”

Coronavirus Disease 2019 (Covid-19) Outbreak and Pituitary Apoplexy

“…Coexistence of PA and COVID-19 infection has been previously reported [17,18]. The signi cance of this correlation is still unclear [17]. Similarly, Chan et al [18] reported another case of a patient with PA who also tested positive for COVID-19 infection, although in this case, pregnancy may have played an important role in the development of the pituitary infarction [19].…”

“…Coexistence of PA and COVID-19 infection has been previously reported [17,18]. The signi cance of this correlation is still unclear [17].…”

Pituitary Apoplexy Attributed to COVID-19 Infection in the Absence of an Underlying Macroadenoma or Other Identifiable Cause

“…Histopathological examinations of brain specimens of patients diagnosed with COVID-19 have shown acute hypoxic injury, with loss of neurons in the absence of thrombi or vasculitis [ 3 ]. Pituitary apoplexy has been attributed to COVID-19 within recent months; however, all of these cases have identified underlying etiologies such as pituitary macroadenomas [ 4 , 5 ]. To our knowledge, this case is the first in the literature to describe pituitary apoplexy, in the absence of a pituitary macroadenoma or other identifiable causes, as a sole complication of COVID-19 infection and its subsequent cerebral hypoxic injury.…”