Pituitary Apoplexy Following Systemic Anticoagulation
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Corticosteroid therapy may be crucial in the emergency setting, and it is recommended for all patients with suspected pituitary apoplexy (PA). Early recognition of PA and its predisposing factors is crucial for the best outcome for the patient. Initial conservative treatment strategies are gaining popularity but close clinical monitoring is fundamental to recognize the need for sellar decompression.

Pituitary apoplexy is a rare medico-surgical emergency that stems from an acute expansion of a pituitary adenoma from infarction or hemorrhage and where the treatment strategy is still controversial. Clinical presentation is highly variable and a high index of suspicion is needed to make the diagnosis. Furthermore, in less than half of cases, a precipitating event is identified.

This is a case of a 74-year-old female who, after the introduction of anticoagulation for pulmonary thromboembolism, presented with pituitary apoplexy heralded by acute adrenal insufficiency, headaches, visual symptoms, and hypogonadotropic hypogonadism. Timely initiation of corticosteroids was crucial, and after stabilization, a conservative treatment strategy was favored with a good long-term prognosis. Long-term follow-up of pituitary function also revealed new growth hormone deficiency.

Conclusively, This case highlights important messages regarding the management of PA that may influence outcomes: early diagnosis, consideration of precipitant factors that may be reversed and initiation of steroids may be crucial in an emergency setting. Deciding on the best treatment strategy depends on the state of consciousness and neuro-ophthalmologic impairment, and should be performed by an experienced multidisciplinary team, as few quality studies exist with respect to deciding on the best candidates for surgical decompression.

Source: https://www.ejcrim.com/index.php/EJCRIM/article/view/1254/1843
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