A case of atypical macroprolactinoma presenting with pituitary apoplexy during pregnancy and review of the literature

Oğuz, Seda Hanife; Söylemezoğlu, Figen; Dağdelen, Selçuk; Erbaş, Tomris

doi:10.1080/09513590.2019.1650339

Cited by 11 publications

(26 citation statements)

References 42 publications

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“…Extremely rare, pituitary apoplexy can occur even in the first trimester as reported by Janssen et al at 10 weeks of gestation (16). Prolactinoma (21 cases) was the most common tumor encountered and in many occasions in patients who (17). There were 17 cases of non-secreting adenoma, 2 cases of GH-oma, 3 cases of hypophysitis, one case of Neslon syndrome, one case of enlarged pituitary gland, one case of pituitary apoplexy followed by reversible cerebral vasoconstrictive syndrome and one case of normal size pituitary gland but with a histopathological diagnosis of adenoma post-surgery (Table II).…”

Section: Discussionmentioning

confidence: 91%

“…In seriously ill patients, the current literature and expert opinion favors surgical decompression. Analysis of 22 cases from Table II showed that surgical decompression in pregnancy is safe without any teratogenic effects (4,9,(17)(18)(19)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)51). The majority of cases were able to deliver in the late 3rd trimester as was exemplified by Oguz et al and Querol Ripoll et al; the authors showed that surgery performed even in the second trimester does not alter pregnancy course (17,34).…”

Section: Discussionmentioning

confidence: 96%

“…There were 17 cases of non-secreting adenoma, 2 cases of GH-oma, 3 cases of hypophysitis, one case of Neslon syndrome, one case of enlarged pituitary gland, one case of pituitary apoplexy followed by reversible cerebral vasoconstrictive syndrome and one case of normal size pituitary gland but with a histopathological diagnosis of adenoma post-surgery (Table II). In many hospitals, current practice is to halt cabergoline/bromocriptine, although there is no robust evidence for this decision (17). Onset of symptoms in a patient with a known adenoma should trigger imagistic investigations that will clarify if this is a case of progressive adenoma or a different aetiology.…”

Section: Discussionmentioning

confidence: 99%

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Pituitary adenoma apoplexy in pregnancy: Case report and literature review

Pop¹,

Ilian

Georgescu

et al. 2022

Exp Ther Med

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Gestational pituitary apoplexy is an extremely rare condition. It is characterised by an unexpected headache, vomiting, nausea, and visual disturbances. Pituitary apoplexy in pregnancy and postpartum is a challenging diagnosis with symptoms overlapping multiple conditions. There is a limited number of articles presenting cases or case series of gestational pituitary apoplexy. This is a potentially life-threatening emergency which requires a high index of suspicion for its diagnosis. This article presents a case of postpartum pituitary apoplexy and outlines the current stage of clinical, imagistic diagnosis and management options. A 26-year-old primipara was submitted to a Caesarean section, with no perioperative incidents. Forty-eight hours later she reported the apparition of frontal and temporal throbbing headaches, nausea, photophobia, and she was diagnosed with a pituitary tumor measuring 33x10.5x15.5 mm. Although initially conservative treatment was proposed, the clinical outcome was not favourable, thus the patient was submitted to endoscopic transsphenoidal resection. The histopathological studies demonstrated the presence of a pituitary macroadenoma. At the 2-year follow-up, the patient is free of disease. Although it represents an extremely rare condition, gestational pituitary apoplexy should be suspected whenever headache and neurological disorders such as nausea and photophobia are reported during the postpartum period.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Pituitary adenoma apoplexy in pregnancy: Case report and literature review

Pop¹,

Ilian

Georgescu

et al. 2022

Exp Ther Med

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“…We included 28 studies on transsphenoidal surgery of pituitary adenomas during pregnancy (28,49,124,135,153,157,168,169,170,171,172,173,174,175,176,177,178,179,180,181,182,183,184,185,186,187,188,189), see Appendix 5 Table 1 for the GRADE evidence, and Appendix 5 Table 2 for study details. Pituitary surgery was performed in 33 cases during pregnancy.…”

Section: Clinical Question V: Is Pituitary Surgery Safe For Pituitary Adenomas During Pregnancy?mentioning

confidence: 99%

“…Transsphenoidal surgery is indicated if medical treatment fails to rapidly induce sufficient tumour shrinkage and symptom relief. Rapid decompressive surgery is also indicated in many cases of progressively symptomatic pituitary apoplexy (181,223), which may cause severe visual defects. In case of sudden and severe headache, ophthalmoplegia or limited visual field impairment, surgery should be discussed case-by-case (255).…”

Section: Rationalementioning

confidence: 99%

ESE Clinical Practice Guideline on functioning and nonfunctioning pituitary adenomas in pregnancy

Luger

Broersen

Biermasz

et al. 2021

European Journal of Endocrinology

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Pregnancies are rare in women with pituitary adenomas, which may relate to hormone excess from secretory subtypes such as prolactinomas or corticotroph adenomas. Decreased fertility may also result from pituitary hormone deficiencies due to compression of the gland by large tumours and/or surgical or radiation treatment of the lesion. Counselling premenopausal women with pituitary adenomas about their chance of conceiving spontaneously or with assisted reproductive technology, and the optimal pre-conception treatment, should start at the time of initial diagnosis. The normal physiological changes during pregnancy need to be considered when interpreting endocrine tests in women with pituitary adenomas. Dose adjustments in hormone substitution therapies may be needed across the trimesters. When medical therapy is used for pituitary hormone excess, consideration should be given to the known efficacy and safety data specific to pregnant women for each therapeutic option. In healthy women, pituitary gland size increases during pregnancy. Since some pituitary adenomas also enlarge during pregnancy, there is a risk of visual impairment, especially in women with macroadenomas or tumours near the optic chiasm. Pituitary apoplexy represents a rare acute complication of adenomas requiring surveillance, with surgical intervention needed in some cases. This guideline describes the choice and timing of diagnostic tests and treatments from the pre-conception stage until after delivery, taking into account adenoma size, location and endocrine activity. In most cases, pregnant women with pituitary adenomas should be managed by a multidisciplinary team in a centre specialised in the treatment of such tumours.

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Prolactinomas in pregnancy: considerations before conception and during pregnancy

Glezer

Bronstein

2019

Pituitary

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A case of atypical macroprolactinoma presenting with pituitary apoplexy during pregnancy and review of the literature

Cited by 11 publications

References 42 publications

Pituitary adenoma apoplexy in pregnancy: Case report and literature review

Pituitary adenoma apoplexy in pregnancy: Case report and literature review

ESE Clinical Practice Guideline on functioning and nonfunctioning pituitary adenomas in pregnancy

Prolactinomas in pregnancy: considerations before conception and during pregnancy

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