Pituitary Apoplexy in a Child with Short Stature and Possible Recent SARS-CoV-2 Infection.

ingentiumby ingentium

In Coronavirus Literature.

Publication date: Jun 07, 2025

Background and Clinical Significance: Pituitary apoplexy is an extremely rare condition in children and adolescents with a rapid onset due to acute hemorrhage, infarction, or both in the pituitary gland. Most frequently, pituitary apoplexy is an asymptomatic or subclinical entity. Few cases of pituitary apoplexy with concurrent SARS-CoV-2 infection or COVID-19 vaccination have been reported. Case Presentation: We present the case of a 13-year-8-month-old boy who presented in our pediatric endocrinology department for the evaluation of short stature. He was previously diagnosed with secondary hypothyroidism and was treated with levothyroxine. At admission, clinical examination revealed a height of 141 cm (-2. 68 SD/-2. 4 SD corrected for mid-parental height), normal weight (60th centile), Tanner-stage G2P1, and delayed bone age. Basal IGF1 was normal, but the tests performed to assess the GH reserve confirmed the GH deficiency (peak GH value 3. 11 ng/mL after clonidine/0. 95 ng/mL after insulin). The brain MRI revealed a subacute pituitary hemorrhage. Thrombophilia and coagulopathies were excluded by further testing. Anti-SARS-CoV-2 (anti-S-protein IgG) antibodies (>200 BAU/mL) were compatible with COVID-19 infection, indicating a possible association between these two entities. At 3-month follow-up, physical examination showed a 3 cm height gain and advancing pubertal development (G4P2). Newer MRI found changes consistent with resolving hemorrhage. The patient was provided immediately with recombinant human GH and aromatase inhibitor therapy to maximize GH treatment response. During follow-up, the rGH dose was adjusted based on IGF1 values, and after 3 years and 10 months, rGH treatment was stopped, reaching a height of 172. 3 cm (-0. 51 SD) and surpassing the initial prediction of 164. 5 cm. Conclusions: Pituitary apoplexy, an even rarer complication in the pediatric population, may be associated with SARS-CoV-2 infection. Further studies are necessary to better understand the intertwining of those conditions.

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Concepts Keywords
Insulin aromatase inhibitor therapy
Old COVID-19
Pediatric pituitary apoplexy
Stage short stature
Thrombophilia

Semantics

Type Source Name
disease MESH Pituitary Apoplexy
disease MESH SARS-CoV-2 Infection
pathway REACTOME SARS-CoV-2 Infection
disease MESH Clinical Significance
disease MESH hemorrhage
disease MESH infarction
disease IDO entity
disease MESH secondary hypothyroidism
drug DRUGBANK Levothyroxine
drug DRUGBANK Mecasermin
drug DRUGBANK Clonidine
disease MESH Thrombophilia
disease MESH infection
drug DRUGBANK Tropicamide
drug DRUGBANK Fica
disease MESH Diabetes Mellitus
disease MESH Emergency
drug DRUGBANK Coenzyme M
disease MESH pituitary adenoma
disease MESH hypertension
drug DRUGBANK Protirelin
drug DRUGBANK Gonadorelin
disease MESH etiology
drug DRUGBANK Sodium lauryl sulfate
disease IDO blood
drug DRUGBANK Hydrocortisone
disease MESH Rathke cleft cysts
disease MESH tumors
drug DRUGBANK Letrozole
drug DRUGBANK Follitropin
drug DRUGBANK Testosterone
disease MESH insulin resistance
pathway KEGG Insulin resistance
disease IDO history
disease MESH adenoma
disease MESH defects
disease MESH ophthalmoplegia
disease MESH papilledema
disease MESH apoplexy
disease IDO symptom
disease MESH visual impairments
disease MESH pituitary insufficiency
disease MESH hypotension
disease MESH hyponatremia
disease MESH treatment delay
disease IDO production
disease MESH Lymphocytic hypophysitis
disease MESH thrombocytopenia
disease MESH liver disease
disease MESH ischemia
drug DRUGBANK Isosorbide
drug DRUGBANK Promazine
drug DRUGBANK Clomifene
disease IDO asymptomatic carrier
disease MESH respiratory distress syndrome
disease MESH ataxia
disease MESH epilepsy
disease MESH neuropathic pain
disease MESH myopathy
disease MESH death
disease IDO cell
drug DRUGBANK Von Willebrand Factor Human
disease MESH thrombosis
drug DRUGBANK Fibrinogen Human
disease MESH upper respiratory tract infection
disease MESH pituitary disease
disease MESH neurologic deficits
drug DRUGBANK L-Valine
disease MESH Amaurosis
drug DRUGBANK Sulfasalazine
drug DRUGBANK Corticotropin
disease MESH Cushing’s Disease
disease MESH brain tumors
disease MESH neuroendocrine tumors
disease MESH Growth Disorders
drug DRUGBANK Somatotropin
disease MESH Hypophysitis
disease MESH Brain Hemorrhages
disease MESH Viral Infection
disease IDO intervention
disease MESH Macroprolactinoma
disease MESH Histiocytosis

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