Related Experiment Videos
Heparin therapy for myocardial infarction: an unusual trigger for pituitary apoplexy
M M Oo1, A Y Krishna, G J Bonavita
1Department of Internal Medicine, Northeastern Ohio University College of Medicine, Canton 44708, USA.
Insights
Heparin anticoagulation for myocardial infarction can precipitate pituitary apoplexy, a rare condition causing central fever and confusion. Early diagnosis of pituitary apoplexy is crucial to prevent severe neurological complications.
Area of Science:
- Neuroendocrinology
- Cardiology
- Neurology
Background:
- Pituitary apoplexy is a rare endocrine emergency.
- Anticoagulation is a known risk factor for pituitary apoplexy.
- The presentation can mimic infectious or other neurological conditions.
Purpose of the Study:
- To report the first case of pituitary apoplexy following heparin anticoagulation for acute myocardial infarction.
- To highlight the diagnostic challenges posed by atypical presentations of pituitary apoplexy.
- To emphasize the importance of early diagnosis and management of pituitary apoplexy.
Main Methods:
- Case report of a 68-year-old male with coronary artery disease.
- Initial management included electric cardioversion and therapeutic heparinization.
- Diagnostic workup involved computed tomography and magnetic resonance imaging of the brain.
- Treatment included stress-dose steroids and transsphenoidal resection of the pituitary adenoma.
Main Results:
- The patient developed symptoms suggestive of central nervous system involvement, including headache, fever, altered sensorium, and hyponatremia.
- Magnetic resonance imaging revealed a pituitary macroadenoma with hemorrhage (pituitary apoplexy).
- Treatment with steroids and subsequent surgery led to resolution of symptoms and stabilization of the patient.
Conclusions:
- This case represents the first instance of pituitary apoplexy occurring after heparin anticoagulation for acute myocardial infarction.
- Pituitary apoplexy can present atypically with central fever and confusion, posing a diagnostic challenge.
- Early recognition of subtle panhypopituitarism symptoms is vital for diagnosing pituitary apoplexy and preventing potentially fatal anticoagulant-induced central nervous system events.
Abstract:
A 68-year-old man with coronary artery disease was admitted for chest pain and ventricular tachycardia. After electric cardioversion, therapeutic heparinization was started for myocardial ischemia and nontransmural infarction. On day 3, headache and fever developed, followed by an altered sensorium and hyponatremia. Infectious etiology for the fever was excluded, and results of computed tomography of the brain were normal. Later magnetic resonance imaging (Day 10) demonstrated a pituitary macroadenoma with hemorrhage. Treatment for panhypopituitarism with stress-dose steroids stabilized the patient, and the fever and hyponatremia resolved. Transsphenoidal resection of the pituitary adenoma was performed without incident. This is the first reported case of pituitary apoplexy after heparin anticoagulation for acute myocardial infarction, although chronic anticoagulation in other settings has been reported as a precipitant of apoplexy. The uncommon presentation of a "central" fever and confusion in a patient with previously undiagnosed adenoma posed a diagnostic challenge. Subtle presentations of panhypopituitarism, knowledge of which should lead to suspicion and early diagnosis of pituitary apoplexy, will prevent anticoagulant-induced central nervous system catastrophes and potential fatalities.