Off-Pump Coronary Artery Bypass Complicated with Third Nerve Palsy: A Case Report

Pituitary apoplexy is a clinical syndrome caused by an acute ischemic or hemorrhagic vascular accident involving a pituitary adenoma or an adjacent pituitary gland. We report an exceedingly rare case of unknown pituitary adenoma that after three-vessel off-pump coronary artery bypass grafting (OPCAB) complicated by hemorrhage. The patient showed hyponatremia, fever, lethargy after surgery. CABG with cardiopulmonary bypass (CPB) is not recommended for patients with neurologic problems such as previous stroke or tumor, however OPCAB also may complicated by pituitary hemorrhage. This case report is the second to describe pituitary hemorrhage after OPCAB. The patient referred for surgery in a neurosurgery center and underwent transesphenoidal resection of adenoma. The sign and symptom of the occulomotor nerve palsy recovered partially in 6th month of follow-up.