Pituitary apoplexy after cardiac surgery in a 14-year-old girl with Carney complex: a case report

• Published in: Endocrine Journal 2019, Vol.66(12), pp.1117-1123
• Main Authors: Naito, Yuki, Mori, Jun, Tazoe, Jun, Tomida, Akimasa, Yagyu, Shigeki, Nakajima, Hisakazu, Iehara, Tomoko, Tatsuzawa, Kazunori, Mukai, Tokuo, Hosoi, Hajime
• Format: Article
• Language: English
• Subjects: Adenoma; Adolescent; Brain tumors; Cardiac myxoma; Cardiac Surgical Procedures - adverse effects; Carney complex; Carney Complex - complications; Carney Complex - diagnosis; Case reports; Decompression; Female; Glucose; Glucose tolerance; Growth Hormone-Secreting Pituitary Adenoma - complications; Growth hormones; Headache; Heart; Heart Neoplasms - surgery; Heart surgery; Humans; Insulin; Magnetic resonance imaging; Mood; Myxoma; Myxoma - surgery; Neoplasm Recurrence, Local - surgery; NMR; Nodules; Nuclear magnetic resonance; Patients; Pituitary; Pituitary apoplexy; Pituitary Apoplexy - etiology; Pituitary Neoplasms - complications; Pituitary Neoplasms - diagnosis; Pituitary Neoplasms - surgery; Pituitary tumor; Thyroid; Thyroid gland; Thyroid-stimulating hormone; Thyrotropin - deficiency; Thyrotropin-releasing hormone; Thyroxine; Tumors; Ultrasound; Visual impairment
• ISSN: 0918-8959; 1348-4540
• DOI: 10.1507/endocrj.EJ19-0183

A 14-year-old girl was referred to our department because of headache and visual impairment following the resection of recurrent cardiac myxoma. Head magnetic resonance imaging (MRI) scan detected an intra- and supra-sellar tumor. Moreover, the patient showed the presence of spotty skin pigmentations on her cheeks and lower lip. Blood examination revealed hypothyrotropinemia, and ultrasonography results revealed multiple thyroid nodules. She was diagnosed with Carney complex (CNC). Her pituitary tumor was suspected as growth hormone (GH)-secreting adenoma, because overgrowth was observed in the patient. However, biochemical examinations, including oral glucose tolerance test, failed to show the characteristic findings of GH-secreting adenoma. In contrast, insulin tolerance test showed GH deficiency. Her visual impairment improved without performing decompression surgery, and the tumor size decreased, as per the MRI findings. Based on clinical course, the patient was diagnosed with pituitary apoplexy in pituitary adenoma, following which she was discharged. At 3 months after discharge, thyrotropin-releasing hormone loading test performed revealed low thyrotropin-stimulating hormone and thyroid hormone levels, and the patient was in a depressed mood. Therefore, l-T4 replacement was initiated, following which her GH secretory capacity gradually improved. Here, we report, to the best of our knowledge, the first case of a patient with pituitary apoplexy in CNC. Such condition must be identified in young patients with recurrent cardiac myxoma, and examinations, such as head MRI, must be performed.