Ischemic pituitary apoplexy associated with the lupus anticoagulant.
OBJECTIVE
To report a case of ischemic pituitary apoplexy secondary to a hypercoagulable state following elective orthopedic surgery.


METHODS
Observational case report.


METHODS
A 48-year-old Caucasian man underwent an uneventful, left-sided total hip replacement and corrective osteotomy of the proximal femur. Two days post-operative, he developed a frontal headache and blurred vision in both eyes.


RESULTS
Ophthalmic examination revealed right VIth cranial nerve palsy. Imaging studies indicated pituitary apoplexy with a large hypodense pituitary lesion with widening of the sella turcica. Laboratory findings included positive lupus anticoagulant, a normal prothrombin time (PT), and an elevated activated partial thromboplastin time (aPTT). Five days after the initial symptoms, a transsphenoidal pituitary resection was performed. At a 6 months follow-up, the VIth nerve paresis was completely resolved.


CONCLUSIONS
This case describes ischemic pituitary apoplexy associated with a pre-operatively elevated aPTT and positive lupus anticoagulant. This is the first report, to our knowledge, of atypical apoplexy concurrent with antiphospholipid (aPL) antibodies following an uneventful surgery. The results we obtained on this patient suggest that an associated hypercoaguable state may increase the risk of thrombosis following elective orthopedic surgery.
Galvin
Jennifer A
JA
Kresge Eye Institute/Wayne State University School of Medicine, Detroit, MI 48201, USA. jgalvin@uic.edu
Van Stavern
Gregory P
GP
D017152:Antibodies, Antiphospholipid / Q000097:blood*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D002545:Brain Ischemia / Q000209:etiology* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010900:Pituitary Diseases / Q000209:etiology* / Q000276:immunology; D011183:Postoperative Complications / Q000145:classification*; D020521:Stroke / Q000209:etiology* / Q000276:immunology
D017152:Antibodies, Antiphospholipid