title: Silent pituitary infarction after coronary artery bypass grafting procedure: case report and review of literature.
abstract: OBJECTIVE
  To report a case of silent pituitary infarction that occurred after a coronary artery bypass grafting procedure and review the relevant literature.
  
  
  METHODS
  We describe a female patient with silent pituitary infarction several months after a coronary artery bypass operation and discuss her presentation, clinical findings, and laboratory evaluation. We also review similar cases in the literature.
  
  
  RESULTS
  A 73-year-old woman presented with generalized fatigue, weakness, and an elevated creatine kinase level several months after she had undergone a coronary artery bypass procedure. The findings on laboratory evaluation were consistent with hypogonadism, growth hormone deficiency, central hypothyroidism, and adrenal insufficiency. Magnetic resonance imaging of the pituitary fossa showed an empty sella turcica and no sellar enlargement. The patient had no headaches, no neuro-ophthalmologic symptoms, and no focal neurologic deficits. The presentation was slow and insidious. The patient received glucocorticoid and thyroid hormone replacement therapy, after which her clinical status improved substantially. Silent pituitary infarction after coronary artery bypass grafting has been reported previously in 3 male patients, but our current case is the first such report in a female patient.
  
  
  CONCLUSIONS
  Silent pituitary infarction can be a complication of a coronary artery bypass grafting procedure, with a delayed and insidious presentation.
authors.affiliation: Division of Endocrinology, Beirut Governmental University Hospital, Beirut, Lebanon.
authors.forename: Dany H
authors.initials: DH
authors.lastname: Zayour
authors.forename: Sami T
authors.initials: ST
authors.lastname: Azar
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007238:Infarction / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D010902:Pituitary Gland / Q000098:blood supply* / Q000473:pathology; D011183:Postoperative Complications / Q000175:diagnosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D013974:Thyroxine / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D005938:Glucocorticoids; D013974:Thyroxine