A Case of Pituitary Hemorrhage Following Cardiopulmonary Bypass Surgery

Abstract

A 68-year-old female patient with previous history of transsphenoidal hypophysectomy operation underwent three-vessel coronary artery bypass graft (CABG) surgery for extensive coronary artery disease. Preoperative neurological examination revealed sequelae visual loss at right temporal visual field. Follow-up Magnetic Resonance Imaging studies showed a residual hypophyseal tumor tissue extending to suprasellar area. No additional pathology was detected in the early postoperative cranial control CT, but aggravation of visual field defect was determined. Coincidently, cranial magnetic resonance imaging (MRI) showed hemorrhage into the tumor tissue. We decided to follow-up the patient who exhibited no additional symptoms and was discharged well on the fifth day due to the signs of resolution of hemorrhage. Follow-up controls of the patient at sixth and twelfth months demonstrated normal hormone levels without any additional clinical complaints. We present preoperative assessment, perioperative anesthesia management, and postoperative clinical follow-up of a patient with a residual hypophyseal tumor.

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O. Kocyigit, S. Kabatas, E. Civelek, E. Tuncay, O. Omay, T. Cansever and A. Turkoz, "A Case of Pituitary Hemorrhage Following Cardiopulmonary Bypass Surgery," Surgical Science, Vol. 2 No. 3, 2011, pp. 159-162. doi: 10.4236/ss.2011.23034.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] M. B. Pliam, M. Cohen, L. Cheng, M. Spaenle, M. H. Bronstein and T. W. Atkin, “Pituitary Adenomas Complicating Cardiac Surgery: Summary and Review of 11 Cases,” Journal of Cardiac Surgery, Vol. 10, No. 2, March 1995, pp. 125-132. doi:10.1111/j.1540-8191.1995.tb01230.x
[2] M. Wiesmann, J. Gliemroth, U. Kehler and U. Missler, “Pituitary Apoplexy after Cardiac Surgery Presenting as Deep Coma with Dilated Pupils,” Acta Anaesthesiologica Scandinavica, Vol. 43, No. 2, February 1999, pp. 236-238. doi:10.1034/j.1399-6576.1999.430222.x
[3] P. Maccagnan, C. L. Macedo, M. J. Kayath, R. G. Nogueira and J. Abucham, “Conservative Management of Pituitary Apoplexy: A Prospective Study,” Journal of Clinical Endocrinology & Metabolism, Vol. 80, No. 7, July1995, pp. 2190-2197. doi:10.1210/jc.80.7.2190
[4] L. C. Glass, “Images in Clinical Medicine. Pituitary Apoplexy,” New England Journal of Medicine, Vol. 349, November 2003, p. 2034.
[5] G. Liberale, G. Bruninx, B. Vanderkelen, E. Dubois, E. Vandueren and G. Verhelst, “Pituitary Apoplexy after Aortic Abdominal Aneurysm Surgery: A Case Report,” Acta Chirurgica Belgica, Vol 106, No. 1, 2006, pp. 77-80.
[6] Z. Chen, A. W. Murray and J. J. Quinlan, “Pituitary Apoplexy Presenting as Unilateral Third Cranial Nerve Palsy after Coronary Artery Bypass Surgery,” Anesthesia & Analgesia, Vol. 98, No. 1, January 2004, pp. 46-48. doi:10.1213/01.ANE.0000093233.84896.27
[7] S. Murad-Kejbou and E. Eggenberger, “Pituitary Apoplexy: Evaluation, Management, and Prognosis,” Current Opinion in Ophthalmology, Vol. 20, No. 6, November 2009, pp. 456-461. doi:10.1097/ICU.0b013e3283319061
[8] R. N. Nawar, D. AbdelMannan, W. R. Selman and B. M. Arafah, “Pituitary Tumor Apoplexy: A Review,” Journal of Intensive Care Medicine, Vol. 23, No. 2, March-April 2008, pp. 75-90. doi:10.1177/0885066607312992
[9] D. C. Bills, F. B. Meyer, E. R. Laws, D. H. Davis, M. J. Ebersold, B. W. Scheithauer, D. M. Ilstrup and C. F. Abboud, “A Retrospective Analysis of Pituitary Apoplexy,” Neurosurgery, Vol. 33, No. 4, October 1993, pp. 602-608. doi:10.1227/00006123-199310000-00007
[10] E. R. Cardoso and E. W. Peterson, “Pituitary Apoplexy. A Review,” Neurosurgery, Vol.14, No. 3, March 1984, pp. 363-373. doi:10.1227/00006123-198403000-00021
[11] M. L. Slavin and M. Budubin, “Pituitary Apoplexy Associated with Cardiac Surgery,” American Journal of Ophthalmology, Vol. 98, No. 3, September1984, pp. 291-296.
[12] D. M. Cooper, M. G. Bazaral, A. J. Furlan, E. Sevilla, M. A. Ghattas, L. R. Sheeler, J. R. Little, J. F. Hahn, W. C. Sheldon and F. D. Loop, “Pituitary Apoplexy: A Complication of Cardiac Surgery,” Annals of Thoracic Surgery, Vol. 41, No. 5, May 1986, pp. 547-550. doi:10.1016/S0003-4975(10)63039-1
[13] E. Levy, A. Korach, G. Merin, M. Feinsod and B. Glenville, “Pituitary Apoplexy and CABG: Should We Change Our Strategy?” Annals of Thoracic Surgery, Vol. 84, No. 4, October 2007, pp. 1388-1390. doi:10.1016/j.athoracsur.2007.05.017
[14] R. E. Warwar, S. S. Bhullar, R. J. Pelstring and R. J. Fadell, “Sudden Death from Pituitary Apoplexy in a Patient Presenting with an Isolated Sixth Cranial Nerve Palsy,” Journal of Neuro-Ophthalmology, Vol. 26, No. 2, June 2006, pp. 95-97. doi:10.1097/01.wno.0000223270.01813.57

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