HEPARIN-THERAPY FOR MYOCARDIAL-INFARCTION - AN UNUSUAL TRIGGER FOR PITUITARY APOPLEXY

A 68-year-old man with coronary artery disease was admitted for chest pain and ventricular tachycardia, After electric cardioversion, therap eutic heparinization was started for myocardial ischemia and nontransm ural infarction, On day 3, headache and fever developed, followed by a n altered sensorium and hyponatremia, Infectious etiology for the feve r was excluded, and results of computed tomography of the brain were n ormal, Later magnetic resonance imaging (Day 10) demonstrated a pituit ary macroadenoma with hemorrhage, Treatment for panhypopituitarism wit h stress-dose steroids stabilized the patient, and the fever and hypon atremia resolved, Transsphenoidal resection of the pituitary adenoma w as performed without incident. This is the first reported case of pitu itary apoplexy after heparin anticoagulation for acute myocardial infa rction, although chronic anticoagulation in other settings has been re ported as a precipitant of apoplexy, The uncommon presentation of a '' central'' fever and confusion in a patient with previously undiagnosed adenoma posed a diagnostic challenge, Subtle presentations of panhypo pituitarism, knowledge of which should lead to suspicion and early dia gnosis of pituitary apoplexy, will prevent anticoagulant-induced centr al nervous system catastrophes and potential fatalities.