title: Pituitary apoplexy after cardiac surgery in a patient with subclinical pituitary adenoma: case report with review of literature.
abstract: We report a case of pituitary apoplexy occurring in a 74-year-old patient 6 hours after cardiac surgery. The patient presented with confusion, unilateral ptosis and ophthalmoplegia. Neurological examination revealed right oculomotor nerve palsy and decreased level of consciousness. Magnetic resonance imaging showed a hemorrhagic and necrotic pituitary macroadenoma. After prompt endocrinological replacement therapy with hydrocortisone and levothyroxine, the confusion of the patient resolved. Removal of a non-functional macroadenoma with large necrotic areas resulted in full recovery. The physician should be aware of pituitary adenoma infarction after open cardiac surgery and should remember that it can be fatal or cause permanent neurological or endocrine damage without proper treatment. Surgical and endocrine treatment can be life-saving procedures.
authors.affiliation: Department of Neurosurgery, Medicana International Hospital, Ankara, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Yakupoglu
authors.forename: Mehmet B
authors.initials: MB
authors.lastname: Onal
authors.forename: Erdinc
authors.initials: E
authors.lastname: Civelek
authors.forename: Atilla
authors.initials: A
authors.lastname: Kircelli
authors.forename: Bulent
authors.initials: B
authors.lastname: Celasun
mesh_terms: D000236:Adenoma / Q000150:complications / Q000000981:diagnostic imaging*; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D008297:Male; D010899:Pituitary Apoplexy / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology*; D010901:Pituitary Function Tests; D010911:Pituitary Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D014057:Tomography, X-Ray Computed
chemical_list: D006854:Hydrocortisone