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MaryO

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

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http://www.jmedicalcasereports.com/content/1/1/74/abstract

 

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

 

Tricia MM Tan , Carmela Caputo , Amrish Mehta , Emma CI Hatfield , Niamh M Martin and Karim M Meeran

 

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

Published: 30 August 2007

Abstract (provisional)

 

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 atypical 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.

 

Conclusions

 

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.

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Thanks for posting this Mary. Some of it is a bit over my head....but I am interested to read about Pituitary Apoplexy as I was diagnosed with it this year - I'll start looking up some of those long words to find out what they mean...LOL!!

 

Diane

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Wouldn't it be nice if the medical community decided it was better to take the little monsters out preemptively rather than risk the possibility of apoplexy.

 

sigh...

 

den

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Wouldn't it be nice if the medical community decided it was better to take the little monsters out preemptively rather than risk the possibility of apoplexy.

 

sigh...

 

den

 

 

You said it, Den. I have a friend with a 9mm tumor, and I can't understand why they aren't just going in to take it out for compression reasons. I thought they did that at 1cm, but I may be imagining that....seems like a lot of risk to leave the bugger in there, eh?

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Mine was 1cm plus and they have had 2 attempts and the little buggar is still there!!!

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