J Korean Neurosurg Soc.  2015 Apr;57(4):289-291. 10.3340/jkns.2015.57.4.289.

Pituitary Apoplexy Following Mitral Valvuloplasty

• Kim YH
• Lee SW
• Son DW
• Cha SH

• KMID: 1956428
• DOI: http://doi.org/10.3340/jkns.2015.57.4.289

Abstract

Pituitary apoplexy is a rare but potentially life-threatening clinical syndrome caused by the sudden enlargement of a pituitary adenoma secondary to hemorrhage or infarction. Pituitary apoplexy after cardiac surgery is a very rare perioperative complication. Factors associated with open heart surgery that may lead to pituitary apoplexy include hemodynamic instability during cardiopulmonary bypass and systemic heparinization. We report a case of pituitary apoplexy after mitral valvuloplasty with cardiopulmonary bypass. After early pituitary tumor resection and hormonal replacement therapy, the patient made a full recovery.

Keyword

Pituitary apoplexy; Mitral regurgitation; Cardiac surgery; Postoperative complications

MeSH Terms

Cardiopulmonary Bypass
Hemodynamics
Hemorrhage
Heparin
Humans
Infarction
Mitral Valve Insufficiency
Pituitary Apoplexy*
Pituitary Neoplasms
Postoperative Complications
Thoracic Surgery
Heparin

Figure

• 

  Fig. 1 Preoperative brain magnetic resonance (MR) images. The T2-weighted coronal (A) and T1-weighted gadolinium sagittal MR images (B) performed before the valvuloplasty demonstrated a 27×17×20 mm mass in the sella turcica with suprasellar extension. The non-contrast T1-weighted MR images (C and D) performed the day after the valvuloplasty revealed slight enlargement of the mass and increased signal intensity suggesting hemorrhage.

• 

  Fig. 2 Histopathological feature of the specimen. Photomicrograph showing tumor cells with coagulative necrosis suggesting pituitary apoplexy (H&E, ×400).

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  Fig. 3 Postoperative brain MR images. At the 1 year post-transsphenoidal resection of the tumor, there was no evidence of remnant tumor (A : coronal, B : sagittal).

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