Pituitary apoplexy presenting as addisonian crisis after coronary artery bypass grafting

Angela Feazel Mattke, John R Vender, Mark P. Anstadt

Research output: Contribution to journalArticle

27 Scopus citations

Abstract

Addisonian crisis, also commonly referred to as adrenal crisis, occurs when the cortisol produced by the adrenal glands is insufficient to meet the body's acute needs. The symptoms are nonspecific and can mimic other processes, such as sepsis. Hypotension, lethargy, and fever can all be presenting signs. Secondary addisonian crisis can also result from pituitary apoplexy. Pituitary apoplexy usually occurs as hemorrhagic or ischemic necrosis in the presence of a pre-existing pituitary adenoma, and is a rare sequela of surgery. The symptoms of pituitary apoplexy are typically impressive and are relieved by urgent transsphenoidal decompression. Hypopituitarism resulting from pituitary apoplexy can be treated with exogenous hormones. The case presented herein illustrates occult pituitary apoplexy that occurred after on-pump coronary artery bypass grafting. In this patient, the initial signs of addisonian crisis were overlooked; however, once recognized, they were reduced dramatically with standard stress-dose cortisone. A suprasellar mass with a cystic component was found on magnetic resonance imaging. The hemorrhagic pituitary gland was treated by transsphenoidal decompression, which relieved the patient's bitemporal hemianopia and 6th-nerve palsy.

Original languageEnglish (US)
Pages (from-to)193-199
Number of pages7
JournalTexas Heart Institute Journal
Volume29
Issue number3
StatePublished - Sep 23 2002

Keywords

  • Addisonian crisis
  • Adenoma/diagnosis/complications
  • Adrenal gland diseases/etiology
  • Adrenal gland hypofunction/diagnosis/drug therapy/physiopathology
  • Cardiopulmonary bypass/adverse effects
  • Coronary artery bypass
  • Hemorrhage/etiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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