Abstract
BackgroundThis report describes the case of a patient whose pituitary microadenoma resolved after he contracted coronavirus disease 2019. To our knowledge, this is one of the first reported cases of pituitary tumor resolution due to viral illness. We present this case to further investigate the relationship between inflammatory response and tumor remission.Case presentationA 32-year-old man in Yemen presented to the hospital with fever, low blood oxygen saturation, and shortness of breath. The patient was diagnosed with coronavirus disease 2019. Past medical history included pituitary microadenoma that was diagnosed using magnetic resonance imaging and secondary adrenal insufficiency, which was treated with steroids. Due to the severity of coronavirus disease 2019, he was treated with steroids and supportive care. Three months after his initial presentation to the hospital, brain magnetic resonance imaging was performed and compared with past scans. Magnetic resonance imaging revealed changes in the microadenoma, including the disappearance of the hypointense lesion and hyperintense enhancement observed on the previous scan.ConclusionsPituitary adenomas rarely undergo spontaneous resolution. Therefore, we hypothesized that tumor resolution was secondary to an immune response to coronavirus disease 2019.
Highlights
This report describes the case of a patient whose pituitary microadenoma resolved after he contracted coronavirus disease 2019
We hypothesized that tumor resolution was secondary to an immune response to coronavirus disease 2019
pituitary apoplexy (PA), a reported cause of remission of a pituitary adenoma, was unlikely in the present case as it generally occurs in patients with macroadenomas and would have led to an empty sella along with symptoms of hypopituitarism, such as hypothyroidism or decreased libido, which were not observed in the present case
Summary
Pituitary adenomas are benign tumors of the anterior pituitary that are true neoplasms according to the results of clonality studies. Two months before the diagnosis of COVID19, the patient developed blurry vision and scotoma in his left eye He had normal thyroid function test results and normal prolactin levels. At the time of COVID19 diagnosis, physical examination showed that the patient was febrile (temperature 38.3 °C) and acyanotic His blood pressure, respiratory rate, pulse rate, glucose level, and oxygen saturation were 117/83 mmHg, 18 breaths per minute, 80 beats per minute, 118 mg/ dL, and 95%, respectively. The patient was administered ceftriaxone (1 g twice daily intravenously), azithromycin (500 mg tablet once daily), and paracetamol (1 g tablet every 6 hours) but did not respond to treatment Two days later, he became severely ill and toxic, and had symptoms of altered mental status, including hallucinations. The patient’s blurry vision improved, and the severity of his headaches decreased drastically
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