Pituitary apoplexy following heart surgery: a comprehensive review of the literature

Pituitary apoplexy (PA) is a clinical syndrome characterized by abrupt infarction or hemorrhage of the hypophysis, typically within a pituitary adenoma. Heart surgery, particularly with the use of cardiopulmonary bypass, has emerged as a significant precipitating factor for PA with 45 cases reported to date. The pathogenesis of PA in this setting is multifactorial and involves a complex interplay between factors related to the surgical procedure and the underlying tumor itself. This rare but potentially sight- and even life-threatening neuroendocrine emergency should be suspected in any patient presenting with sudden neuro-ophthalmological impairment accompanied by headache after a cardiac operation. PA as a complication of heart surgery predominantly affects men in their sixth or seventh decade of life and most commonly manifests in the early postoperative period. Although PA associated with cardiac surgery generally carries a favorable prognosis, it remains a severe condition with potential for poor outcomes. Awareness of the risk of PA after heart surgery, heightened clinical vigilance in the perioperative period, and familiarity with its clinical, radiological, and laboratory characteristics are crucial for prompt diagnosis and appropriate management by a multidisciplinary team, thereby reducing the risk of irreversible neuro-ophthalmic and endocrine dysfunction and death.