Reactions 1485, p14 - 25 Jan 2014

SDabigatran etexilate

Pituitary apoplexy in an elderly patient: case reportAn 85-year-old man with atrial fibrillation developed

pituitary apoplexy while receiving dabigatran etexilate [routenot stated].

The man, who had dyslipidaemia and diabetes, had beendiagnosed with a non-functioning pituitary adenoma 2 yearspreviously. He had been receiving anticoagulant therapy withwarfarin for non-valvular atrial fibrillation for 7 years. Oneweek after switching from warfarin to dabigatran etexilate110mg twice daily, he was hospitalised with a 4-day history ofheadache and a 2-day history of left-sided ptosis. Othersymptoms included ophthalmoplegia, mydriasis and an absentlight reflex.

Dabigatran etexilate was discontinued. Laboratoryinvestigations included the following: activated partialthromboplastin time 56s, creatinine clearance 37.6 mL/min,sodium cortisol 1.1 µg/dL and adrenocorticotropic hormone6 pg/mL. MRI imaging showed a pituitary tumour extendinginto the bilateral cavernous sinuses, with intratumoralparenchymal haemorrhage invading mainly into the left lobe. Adiagnosis of pituitary apoplexy was made. The man wastreated with levothyroxine sodium and steroids, and warfarinwas resumed. A repeat MRI on day 13 demonstrated that thehaematoma had shrunk. His headache resolved within 1 week,and his eye movements and ptosis improved over thefollowing 3 months. At last follow-up, he continued toexperience left-sided mydriasis.

Author comment: "We report a case of pituitary apoplexyduring treatment with dabigatran."Uemura M, et al. Pituitary apoplexy during treatment with dabigatran. Neurologyand Clinical Neuroscience 1: 82-83, No. 2, Mar 2013. Available from: URL: http://dx.doi.org/10.1002/ncn3.18 - Japan 803098410

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Reactions 25 Jan 2014 No. 14850114-9954/14/1485-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved