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Published on: July 21, 2013
[Pituitary apoplexy following coronary bypass surgery: A case report and literature review]
A Semenov1, E Denoix1, M Thiebaut1
1Service de médecine interne, Hôpital Européen Georges Pompidou, 20-40, rue Leblanc, 75015 Paris, France; AP-HP Centre, Université de Paris, Faculté de médecine Paris Descartes, France.
Insights
Pituitary apoplexy, a rare complication following cardiac surgery, presents with sudden headache and visual issues. Prompt diagnosis and surgical decompression can improve patient outcomes.
Area of Science:
- Neuroendocrinology
- Neurosurgery
- Cardiology
Background:
- Pituitary apoplexy is a rare condition involving pituitary hemorrhage or infarction, often occurring in patients with undiagnosed pituitary adenomas.
- Cardiac surgery, particularly coronary artery bypass grafting, is an identified precipitating factor for pituitary apoplexy.
- The condition typically manifests with sudden severe headache, visual disturbances, and potential endocrinological dysfunction.
Observation:
- An 82-year-old male experienced sudden headache, delirium, and cranial nerve deficits post-coronary artery bypass surgery.
- Diagnostic imaging (MRI and CT-scan) confirmed pituitary apoplexy.
- The patient underwent trans-sphenoidal surgical decompression 13 days after his cardiac surgery.
Findings:
- Surgical decompression led to immediate improvement in the patient's delirium.
- Partial recovery of visual disturbances was observed following the intervention.
- Pituitary apoplexy can occur after various surgical procedures, not limited to cardiac surgery.
Implications:
- Early consideration of pituitary apoplexy is crucial in the postoperative period for patients presenting with severe headache and visual disturbances.
- Pituitary apoplexy is a rare but potentially life-threatening complication associated with cardiac surgery and cardiopulmonary bypass.
- Timely diagnosis and management, including surgical decompression, can mitigate severe neurological and visual deficits.
Introduction:
Pituitary apoplexy is a >rare entity that presents with a sudden onset of headache associated with visual and endocrinological disturbances due to pituitary hemorrhage or infarction. It usually occurs in patients with an unknown pituitary adenoma. Cardiac surgery, and especially coronary artery bypass grafting, can be a precipitating factor in these patients.
Case Report:
We report an 82-year-old male patient who presented with sudden headache and delirium, a right sixth cranial nerve palsy, a right temporal hemianopsia, and a severe loss of left eye visual acuity in the immediate post-operative course of a coronary artery bypass surgery. Pituitary apoplexy was demonstrated on both MRI and CT-scan. Trans-sphenoidal surgical decompression was performed 13 days after coronary artery bypass grafting, with immediate beneficial effect on the delirium and a partial recovery of visual disturbances.
Conclusion:
Pituitary apoplexy is a rare and life-threatening complication that may occur after cardiac surgery (coronary artery bypass, cardiac valve surgery), often precipitated by the use of cardiopulmonary bypass. It can occur after other surgical procedures (orthopedic, digestive, thoracic). The diagnosis must be considered during the early postoperative period in the presence of unusual and severe headache associated with visual disturbances.
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