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

Tricia MM Tan¹ , Carmela Caputo¹ , Amrish Mehta² , Emma CI Hatfield¹ , Niamh M Martin¹ and Karim Meeran¹

¹Endocrine Unit, Hammersmith Hospitals NHS Trust, Imperial College Faculty of Medicine, London, UK

²Department of Radiology, Hammersmith Hospitals NHS Trust, Imperial College Faculty of Medicine, London, UK

author email corresponding author email

Journal of Medical Case Reports 2007, 1:74doi:10.1186/1752-1947-1-74


Published:	30 August 2007

Abstract

Background

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.

Case presentation

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.

Conclusion

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.