Pituitary adenomas and COVID-19 related disease in pandemic time: Clinical, pathological, immunohistochemical, and ultrastructure analysis

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.