Pituitary macroadenomas: are combination antiplatelet and anticoagulant therapy contraindicated? A case report

<p>Abstract</p> <p>Background</p> <p>Pituitary apoplexy is a life-threatening endocrine emergency that is caused by haemorrhage or infarction of the pituitary gland, commonly within a pituitary adenoma. Patients classically present with headache, ophthalmoplegia, visual field defects and altered mental state, but may present with a typical symptoms such as fever and altered conscious level.</p> <p>Case presentation</p> <p>A 57-year-old female with a known pituitary macroadenoma was treated for suspected acute coronary syndrome with aspirin, clopidogrel and full dose enoxaparin. She developed a severe and sudden headache, nausea and vomiting and visual deterioration. A CT scan showed haemorrhage into the pituitary macroadenoma. She underwent neurosurgical decompression. Post-operatively her visual fields and acuity returned to baseline. She was continued on hydrocortisone and thyroxine replacement on discharge.</p> <p>Conclusion</p> <p>This case illustrates the risks of anticoagulation in a patient with a known pituitary macroadenoma, and raises the issue of whether these tumours present a relative contraindication to the use of dual antiplatelet and anticoagulation in acute coronary syndrome.</p

Application of extended transbasal approach to pituitary adenomas

Although transsphenoidal approach is the standard and the method of choice for almost all patients with pituitary adenomas, in some cases the extensions and size of tumour make the transsphenoidal approach insufficient. We have applied in such cases an extended transbasal approach for better visualisation of the tumour and better control of the adjacent structures. Between 1998 and 2004 615 patients with pituitary adenomas were operated upon by our team. 520 patients underwent transsphenoidal procedure whereas 82 with extensive suprasellar and lateral growth of the tumour were treated with extended transbasal approach. 13 patients were treated with other skull base approaches. Mortality in the group of patients operated upon with extended transbasal approach was 3,6% and all these events occurred in first two years. Total removal of the tumour was achieved in 79% of procedures and subtotal in 19%. Cerebrospinal fluid leak was observed in 6% of cases. Transnasal transsphenoidal approach can be used for removal of the majority of pituitary adenomas. Extended transbasal approach is very useful in selected cases, offering an excellent view into parasellar area and minimizing the brain retraction