Pituitary apoplexy following lumbar fusion surgery in prone position: A case report

RATIONALE: Pituitary apoplexy (PA) is a syndrome caused by acute hemorrhage or infarction of the pituitary gland, generally within a pituitary adenoma. PA following spinal surgery is a very rare complication and may be difficult to diagnose. However, early diagnosis of PA is essential for the timely treatment of pan-hypopituitarism and prevention of severe neurologic complications. PATIENT CONCERNS: A 73-year-old man had a posterior lumbar fusion surgery over a period of 8 hours on prone position. The patient complained of severe intractable headache accompanied by ophthalmalgia and ptosis on right eye 2 days after the surgery. DIAGNOSIS: Brain magnetic resonance imaging revealed a 1.3 × 2.6 × 2 cm mass in the sellar fossa and suprasellar region and the laboratory tests indicated pan-hypopituitarism. INTERVENTIONS: High-dose intravenous steroid therapy and trans-sphenoidal hypophysectomy were performed. OUTCOMES: Pathological evaluation of the surgical specimen revealed a pituitary adenoma with total necrosis, indicating that the PA occurred because of tumor infarction. The patient recovered fully after resection of the pituitary adenoma and hormonal therapy. LESSONS: Even though the incidence is low, PA has been related to blood pressure fluctuations or vasospasm during surgery. PA should be considered during differential diagnosis in cases of postoperative severe headache or ophthalmic complications.