Pituitary adenomas and COVID-19 related disease in pandemic time: Clinical, pathological, immunohistochemical, and ultrastructure analysis
Keywords:
Pituitary adenoma, Pituitary apoplexy, COVID-19, endothelial cells, vascular injury.Abstract
Introduction:
Methods: 47 patients were emergency operated on due to pituitary apoplexy during the pandemic
time. The patients were divided into two groups according to PCR COVID-19 positive vs negative
test. Histopathology all cases showed varying degrees of necrosis, microthrombi formation secondary
to inflammation, and endothelial cells injuries in association with TNFa, TNFk, FVIII, DPGF, HIF1a,
Il6, Il10, Il17, DPGF, CD3, CD4, CD8, CD20, CD68, CD163, ACE2, and antiCOV immunoexpression.
Results: 24 women and 23 men, age ranges from 21 to 76 years (mean 42.25±13.38), 14 (36%) presented
positive COVID19 tests, and 30 (64%) were covid negative. 15 were already recurrences, 4 recurrences
in the same year, and 4 died during the pandemic time. 9 (30%) showed histological data of stroke,
of which necrosis around <25% were 8 (47%), 25-50% were 2 (12%) and >50% were 8 (45%). Weak
vascular changes in 4 (24%), moderate in 7 (65%) and severe in 1, moderate, and intense in 1 (6%) were
observed.
Conclusions: Apoplexy in a previously diagnosed macro-PAD in the setting of a recent COVID-19
infection. The patients who presented with histological features of pituitary tumor infarction alone had
less severe clinical features on presentation, a longer course before presentation, and a better outcome
than those presenting with hemorrhagic infarction or frank hemorrhage. Hyperactivated and dysregulated
immune cells pose a substantial danger for exacerbated tissue damage. COVID-19 may increase the risk
of pituitary apoplexy, and we should be vigilant for signs of this. A more insidious pathological link
between COVID-19 and apoplexy may exist in addition to severe inflammatory response.