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Ann Pediatr Endocrinol Metab > Volume 28(1); 2023 > Article
Agrawal and Arya: Reply to Commentary on "Pituitary apoplexy in an adolescent male with macroprolactinoma presenting as middle cerebral artery territory infarction"
To the editor,
We read with interest the comments regarding our recently published article “Pituitary apoplexy in an adolescent male with macroprolactinoma presenting as middle cerebral artery territory infarction” and have addressed them below to the best of our knowledge [1].
Firstly, we accept the raised point based on recent published literature that patients presenting with pituitary apoplexy should be tested for coronavirus disease 2019 (COVID-19). However, the mentioned adolescent patient presented before the onset of COVID-19 pandemic and hence could not have been tested for it. Prepandemic, this case has been presented as a poster in annual meeting of European Society of Paediatric Endocrinology in September 2019 in Vienna, Austria [2].
Secondly, the article does not claim that our patient is the third adolescent patient with pituitary apoplexy. The uniqueness of this case is due to the presentation with ischemic stroke secondary to pituitary apoplexy, and we could find only two cases previously reported with similar presentation [3,4].
Thirdly, partial occlusion is a commonly used term. Regrettably, we do not agree that the word “occlusion” is used only in the context of “all or none” situation. Computed tomography angiography, with sensitivity and specificity of up to 98%, has been shown to be highly accurate for the detection of arterial occlusion and hence extremely unlikely to have missed an occlusion elsewhere [5]. We speculate that the presence of ischemic stroke only in the territory of left middle cerebral artery was due to presence of good collateral blood vessels in the right middle cerebral artery region.


Conflicts of interest

No potential conflict of interest relevant to this article was reported.


1. Agrawal P, Newbold S, Busaidi AA, Kapoor RR, Thomas N, Aylwin SJ, et al. Pituitary apoplexy in an adolescent male with macroprolactinoma presenting as middle cerebral artery territory infarction. Ann Pediatr Endocrinol Metab 2022;27:320–4.
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2. Newbold S, Arya VB, Kapoor RR, Thomas N, Fox K, Aylwin SJ, et al. Macroprolactinoma presenting with Pituitary Apoplexy associated with middle cerebral artery infarction in an adolescent male [abstract P2-231]. Horm Res Paediatr 2019;91(Suppl 1):468–9.

3. Pozzati E, Frank G, Nasi MT, Giuliani G. Pituitary apoplexy, bilateral carotid vasospasm, and cerebral infarction in a 15-year-old boy. Neurosurgery 1987;20:56–9.
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4. Kasl RA, Hughes J, Burrows AM, Meyer FB. Pediatric ischemic stroke from an apoplectic prolactinoma. Childs Nerv Syst 2015;31:1387–92.
crossref pmid pdf
5. Bash S, Villablanca JP, Jahan R, Duckwiler G, Tillis M, Kidwell C, et al. Intracranial vascular stenosis and occlusive disease: evaluation with CT angiography, MR angiography, and digital subtraction angiography. AJNR Am J Neuroradiol 2005;26:1012–21.
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