[h=1][/h] A NOVEL ASSOCIATION BETWEEN PITUITARY TUMOR APOPLEXY AND INFLUENZA A
Tariq Yousuf MD, Lima Lawrence MD, Anne Bacal MD, Armand Krikorian MD, FACE Advocate Christ Medical Center, Department of Internal Medicine; Oak Brook, IL.
[SIZE=-1]Keywords:
Pituitary Apoplexy,
Influenza,
Pituitary Tumor[/SIZE]
Objective/Introduction: Pituitary adenomas have a population prevalence of less than 0.1%. They can rarely present with serious complications such as pituitary tumor apoplexy with symptoms of sudden severe headache, vision impairment, nausea and vomiting. To date, there has been no proven underlying mechanism for the development of pituitary apoplexy. We report a novel association between pituitary tumor apoplexy and influenza A indicating an inflammatory pathology underlying influenza infection contributing to hemorrhage.
Case Description: Our patient is a 44 year old female with past medical history of hypertension and diabetes mellitus type II who presented with a 2 day history of visual deficits, progressively worsening headache and dizziness. She endorsed fever, chills, myalgias and cough. Influenza A was positive. MRI of the brain revealed a large suprasellar macroadenoma with internal hemorrhage. She underwent emergent transsphenoidal excision of pathology proven pituitary adenoma with apoplexy. Signs of SIADH and DI were frequently checked postoperatively and were absent. She received a five day course of oseltamivir and was discharged on levothyroxine 75 mcg per day and maintenance steroids with oral hydrocortisone.
Conclusion: Our patient developed pituitary apoplexy while symptomatic with a laboratory proven diagnosis of influenza A. Hemorrhage associated with influenza A has been described in multiple organs making this case of pituitary apoplexy more than just a coincidental finding. We hypothesize an underlying inflammatory pathology due to influenza A infection contributed to the development of pituitary apoplexy in our patient. We recommend vaccination against influenza A for healthy adults and at-risk populations based on CDC guidelines.
Correspondence address: Tariq Yousuf MD, Advocate Christ Medical Center, Department of Internal Medicine, 4440 W 95th St, Oak Lawn, IL 60453, Email...
