Pituitary apoplexy following coronary artery bypass surgery

Pituitary apoplexy is a syndrome with variable clinical manifestations depending on which parasellar structures (such as the optic nerves and chiasm, cavernous and sphenoid sinuses, or the hypothalamus) are compressed when the pituitary undergoes rapid enlargement. Factors associated with cardiopulmonary bypass that may lead to pituitary apoplexy include ischemia, hemorrhage, edema, and positive pressure ventilation. Seven cases of pituitary apoplexy following cardiopulmonary bypass have been reported, including the present case. Transsphenoidal surgical decompression in the present case and those previously reported appears to be safe after cardiac surgery and may be helpful in amelioration of compression of nearby structures. Pituitary apoplexy should be considered as a diagnostic possibility in patients who develop visual disturbances or ophthalmoplegia following open heart surgery.