title: Pituitary macroadenomas: are combination antiplatelet and anticoagulant therapy contraindicated? A case report.
abstract: 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.
authors.affiliation: Endocrine Unit, Hammersmith Hospitals NHS Trust, Imperial College Faculty of Medicine, London, UK. ttan@hhnt.nhs.uk.
authors.forename: Tricia Mm
authors.initials: TM
authors.lastname: Tan
authors.forename: Carmela
authors.initials: C
authors.lastname: Caputo
authors.forename: Amrish
authors.initials: A
authors.lastname: Mehta
authors.forename: Emma Ci
authors.initials: EC
authors.lastname: Hatfield
authors.forename: Niamh M
authors.initials: NM
authors.lastname: Martin
authors.forename: Karim
authors.initials: K
authors.lastname: Meeran