7498 Pituitary Apoplexy Associated With COVID 19 Infection in a 55 Year Old Filipino Male: A Case Report

Abstract

Abstract Disclosure: C.L. Macrohon: None. J.Y. Mercado: None. R.G. Gan: None. Introduction: Pituitary apoplexy is a rare fatal disorder resulting from acute ischemia or hemorrhage of the pituitary gland. Major predisposing factors include patients with anti-thrombotic drugs. However, there has been an increasing number of cases reported associating COVID- 19 and pituitary apoplexy. Case: This is a case of a 55-year-old Filipino male, who came in with right eye ptosis and blurring of vision associated with headache and dizziness. Significantly, 2 weeks prior the patient had developed cough and colds. On admission, he was noted to be febrile and presented with a visual acuity of light perception on the right eye and hand movements on the left. Plain MRI of the brain revealed a well-circumscribed hemorrhagic sellar-suprasellar mass with mass effect on adjacent structures worrisome for pituitary apoplexy. Incidentally, patient tested positive for COVID- 19. Hormonal work- up revealed hypopituitarism presenting with central hypothyroidism and hypogonadism. Patient was then started on Hydrocortisone 100mg intravenously as loading dose then 50mg intravenously every 6 hours to cover for adrenal insufficiency. At this point, thyroid hormone replacement was also started at 100mcg/day. Initially, patient was scheduled for endoscopic endonasal transsphenoidal surgery. However, due to euvolemic hyponatremia with a serum sodium of 119mmol/L secondary to SIADH, surgery was delayed and was performed on the fourth day of admission. Post- operatively, patient had improvement of vision and was eventually discharged stable without any complications. He was sent home on thyroid hormone replacement and steroids were discontinued since adrenal insufficiency was ruled out with a post operative serum Cortisol of 27.27ug/dL taken 24 hours after last dose of hydrocortisone. Discussion: COVID- 19 with associated hypophysitis or pituitary apoplexy has been reported in literature. The pituitary gland was proposed as possible targets of SAR- CoV-2 due to the presence of ACE- 2 receptors on the surface of their cells. Hazzi et al. discussed that infection by COVID-19 could play a role in the disruption of the equilibrium between the high energy demand and limited blood supply of underlying adenomas. They also discussed on possible routes of entry of COVID 19 particularly thru the nasopharyngeal epithelium via olfactory nerve or pass through blood brain barrier or thru the median eminence. Other possible contributing factors may be due to coagulopathy, endothelial dysfunction and hypercoagulative state seen in COVID- 19. Conclusion: With increasing reports of pituitary apoplexy in the setting of SARS-COV-2 infection there is a possibility that COVID 19 may be a risk factor for pituitary apoplexy. Hence, the prevalence of COVID- 19 may increase risk of patients with underlying pituitary tumors to develop pituitary apoplexy. Presentation: 6/2/2024