title: Unusual Complication of Pituitary Macroadenoma: A Case Report and Review.
abstract: BACKGROUND Pituitary macroadenoma is a common benign tumor that usually presents with visual field defects or hormonal abnormalities. Cerebral infarction can be a complication of a large pituitary adenoma. We report a rare case of bilateral anterior cerebral arteries infarcts by a large pituitary macroadenoma with apoplexy. CASE REPORT A 48-year-old male patient presented with altered conscious level and sudden loss of vision for one-day duration. Magnetic resonance imaging of the brain showed a large seller and suprasellar hemorrhagic mass of pituitary origin, with associated bilateral areas of diffusion restriction in the frontal parasagittal regions, consistent with infarctions. Magnetic resonance angiography showed elevation and compression of A1 segment of both anterior cerebral arteries by the hemorrhagic pituitary macroadenoma. The patient underwent trans-sphenoidal resection of the pituitary adenoma, but unfortunately, ischemia was irreversible. Computed tomography (CT) done post-operatively showed hypodensity in the frontal and parietal parasagittal areas, which was also persistent in the follow up CT scans. The patient's neurological function remained poor, with GCS of 8/15, in vegetative state. CONCLUSIONS Vascular complications of the pituitary apoplexy, although uncommon, can be very severe and life threatening. Early detection of vascular compromise caused by hemorrhagic pituitary macroadenoma can prevent delay in intervention. Clinicians should also consider pituitary adenoma as a possible cause of stroke.
authors.affiliation: Department of Clinical Imaging, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Mohamed Said
authors.initials: MS
authors.lastname: Abbas
authors.affiliation: Department of Clinical Imaging, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Mohammad Najm
authors.initials: MN
authors.lastname: AlBerawi
authors.affiliation: Department of Pathology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Issam
authors.initials: I
authors.lastname: Al Bozom
authors.affiliation: Department of Anesthesiology/SICU and Perioperative Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Nissar F
authors.initials: NF
authors.lastname: Shaikh
authors.affiliation: Department of Clinical Imaging, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Khalid Yacout
authors.initials: KY
authors.lastname: Salem
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010899:Pituitary Apoplexy / Q000150:complications* / Q000000981:diagnostic imaging; D010911:Pituitary Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed