Silent Pituitary Infarction After Coronary Artery Bypass Grafting Procedure: Case Report and Review of Literature

Dany H. Zayour, MD; Sami T. Azar, MD

Disclosures

Endocr Pract. 2006;12(1):59-62. 

In This Article

Abstract and Introduction

Objective: To report a case of silent pituitary infarction that occurred after a coronary artery bypass grafting procedure and review the relevant literature.
Methods: We describe a female patient with silent pituitary infarction several months after a coronary artery bypass operation and discuss her presentation, clinical findings, and laboratory evaluation. We also review similar cases in the literature.
Results: A 73-year-old woman presented with generalized fatigue, weakness, and an elevated creatine kinase level several months after she had undergone a coronary artery bypass procedure. The findings on laboratory evaluation were consistent with hypogonadism, growth hormone deficiency, central hypothyroidism, and adrenal insufficiency. Magnetic resonance imaging of the pituitary fossa showed an empty sella turcica and no sellar enlargement. The patient had no headaches, no neuro-ophthalmologic symptoms, and no focal neurologic deficits. The presentation was slow and insidious. The patient received glucocorticoid and thyroid hormone replacement therapy, after which her clinical status improved substantially. Silent pituitary infarction after coronary artery bypass grafting has been reported previously in 3 male patients, but our current case is the first such report in a female patient.
Conclusion: Silent pituitary infarction can be a complication of a coronary artery bypass grafting procedure, with a delayed and insidious presentation.

Pituitary infarction has been reported in conjunction with several conditions, including sickle cell disease,[1] gastrointestinal hemorrhage,[2] diabetes,[3] and before[4] and after[5] childbirth. Unlike the typically florid manifestation of pituitary apoplexy caused by an acute hemorrhage into a pituitary tumor, pituitary infarction is a silent and indolent condition.[6] We found 3 published case reports of silent pituitary infarction after a coronary artery bypass grafting procedure.[7,8] In this report, we describe a fourth case of pituitary infarction that developed insidiously during coronary artery bypass grafting and resulted in panhypopituitarism, which manifested several months postoperatively. We also undertook a review of the literature in an effort to gain a better understanding of the natural history of this potential complication.

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