Pituitary apoplexy after anticoagulation for unstable angina

To describe a patient with an undiagnosed pituitary macroadenoma, in whom pituitary apoplexy developed after heparin anticoagulation for treatment of unstable angina.

We chronicle the clinical course, treatment, and outcome in a 53-year-old woman with pituitary apoplexy. Potential risk factors are also discussed.

In a patient with coronary artery disease and unstable angina, heparin anticoagulation therapy was initiated. Shortly thereafter, severe frontal headaches, nausea and vomiting, high fever, diplopia, and visual field deficits developed. A workup for infectious causes and analysis of cerebrospinal fluid were negative. Contrast-enhanced computed tomography of the head revealed a pituitary macroadenoma with a central area of hemorrhage, and pituitary apoplexy was diagnosed. Hydrocortisone sodium succinate was administered intravenously, and ultimately, transsphenoidal resection was performed. Postoperatively, diabetes insipidus developed and persisted. Neurologically, she had near-total blindness of the right eye and temporal hemianopia of the left eye.

Although pituitary apoplexy is rare, its occurrence can be associated with certain risk factors, including anticoagulation. Clinicians should be aware of this serious condition so that timely diagnosis and treatment can provide the best chance of recovery.