Pituitary Apoplexy Induced by Anticoagulant Therapy in Patient with Acute Coronary Syndrome
Laporan Kasus
DOI:
https://doi.org/10.55175/cdk.v51i7.1023Kata Kunci:
Antikoagulan, apopleksi, tumor hipofisisAbstrak
Apopleksi hipofisis didefinisikan sebagai perdarahan atau infark kelenjar hipofisis, dapat terjadi pada tumor hipofisis yang belum terdiagnosis. Beberapa mekanisme yang diduga memicu apopleksi hipofisis adalah fluktuasi tekanan darah, stimulasi hormonal pada kelenjar hipofisis, gangguan koagulasi, atau gangguan vaskular. Kasus laki-laki, berusia 73 tahun, warga negara India, dengan keluhan nyeri dada sejak 4 jam yang lalu. Pemeriksaan elektrokardiografi (EKG) dan laboratorium mengarah pada sindrom koroner akut (SKA). Pasien diberi fondaparinux, aspirin, dan clopidogrel. Pada hari ke-4 perawatan pasien nyeri kepala berat, muntah menyembur, dan pandangan ganda. Pemeriksaan radiologis menunjukkan tumor hipofisis dengan tanda-tanda perdarahan tersebar yang mengkompresi kiasma optik, menunjukkan apopleksi tumor hipofisis. Pemeriksaan fungsi hormon menunjukkan tumor hipofisis yang tidak mensekresi hormon. Pengencer darah dihentikan kemudian diberi vitamin K dan dexamethasone. Setelah beberapa hari, nyeri kepala dan pandangan ganda membaik. Pemeriksaan MRI kepala ulang mendapatkan massa tetap dan perdarahan tidak bertambah. Tumor hipofisis bisa menjadi kontraindikasi relatif penggunaan antiplatelet ganda dan antikoagulan pada sindrom koroner akut, terutama pada kelompok komorbiditas penyakit ginjal atau hati.
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