Pituitary macroadenomas: are combination antiplatelet and anticoagulant therapy contraindicated? A case report.
BACKGROUND
Pituitary apoplexy is a life-threatening endocrine emergency that is caused by haemorrhage or infarction of the pituitary gland, commonly within a pituitary adenoma. Patients classically present with headache, ophthalmoplegia, visual field defects and altered mental state, but may present with a typical symptoms such as fever and altered conscious level.


METHODS
A 57-year-old female with a known pituitary macroadenoma was treated for suspected acute coronary syndrome with aspirin, clopidogrel and full dose enoxaparin. She developed a severe and sudden headache, nausea and vomiting and visual deterioration. A CT scan showed haemorrhage into the pituitary macroadenoma. She underwent neurosurgical decompression. Post-operatively her visual fields and acuity returned to baseline. She was continued on hydrocortisone and thyroxine replacement on discharge.


CONCLUSIONS
This case illustrates the risks of anticoagulation in a patient with a known pituitary macroadenoma, and raises the issue of whether these tumours present a relative contraindication to the use of dual antiplatelet and anticoagulation in acute coronary syndrome.
Tan
Tricia Mm
TM
Endocrine Unit, Hammersmith Hospitals NHS Trust, Imperial College Faculty of Medicine, London, UK. ttan@hhnt.nhs.uk.
Caputo
Carmela
C
Mehta
Amrish
A
Hatfield
Emma Ci
EC
Martin
Niamh M
NM
Meeran
Karim
K