Pituitary apoplexy and rivaroxaban

Area of Science:

• Neuroendocrinology
• Neurosurgery
• Oncology

Background:

• Pituitary apoplexy (PA) is a rare clinical emergency characterized by sudden hemorrhage or infarction within a pituitary adenoma.
• Risk factors for PA include anticoagulation therapy, which can increase the likelihood of bleeding events.
• Newer oral anticoagulants, such as rivaroxaban, are increasingly used, necessitating an understanding of their potential complications.

Observation:

• A 73-year-old patient presented with acute severe headache and visual field deterioration, indicative of a potential pituitary event.
• Imaging revealed a massive hemorrhagic and necrotic rearrangement within a pituitary adenoma, consistent with pituitary apoplexy.
• The patient was on rivaroxaban, a direct factor Xa inhibitor, at the time of the event.

Findings:

• This case represents the first documented instance of pituitary apoplexy occurring in a patient treated with rivaroxaban.
• Surgical intervention was performed to address the acute pituitary apoplexy.
• Residual tumor post-surgery led to a decision for radiotherapy treatment three months later.

Implications:

• The findings suggest that novel oral anticoagulants like rivaroxaban may be a potential risk factor for pituitary apoplexy.
• This case underscores the importance of considering anticoagulation status in patients presenting with symptoms suggestive of pituitary apoplexy.
• Further research is warranted to elucidate the precise relationship between rivaroxaban and pituitary apoplexy and to guide clinical management.