Pituitary Apoplexy Following Systemic Anticoagulation

Pituitary apoplexy is a rare medico-surgical emergency that stems from an acute expansion of a pituitary adenoma from infarction or haemorrhage and where the treatment strategy is still controversial. Clinical presentation is highly variable and a high index of suspicion is needed to make the diagnosis. Furthermore, in less than half of cases, a precipitating event is identified. We report a case of a 74-year-old female who, after introduction of anticoagulation for pulmonary thromboembolism, presented with pituitary apoplexy heralded by acute adrenal insufficiency, headaches, visual symptoms and hypogonadotropic hypogonadism. Timely initiation of corticosteroids was crucial, and after stabilisation, a conservative treatment strategy was favoured with good long-term prognosis. Long-term follow-up of pituitary function also revealed new growth hormone deficiency. LEARNING POINTS: Corticosteroid therapy may be crucial in the emergency setting, and it is recommended for all patients with suspected pituitary apoplexy (PA). Early recognition of PA and its predisposing factors is crucial for the best outcome for the patient. Initial conservative treatment strategies are gaining popularity but close clinical monitoring is fundamental to recognise the need for sellar decompression.