An unexpected headache: pituitary apoplexy in a pregnant woman on anticoagulation

Watson, Vanessa

doi:10.1136/bcr-2015-210198

Cited by 10 publications

(17 citation statements)

References 21 publications

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“…Analysis of cases treated conservatively showed that this is a viable and safe option in a patient without visual field defects. Overall, in 16 cases there was full recovery of endocrinological function and in 21 cases, various degree of insufficiency ranging from diabetes insipidus to panhypopituitarism and cranial nerve palsy being encountered (4,7,9,19,24,26,29,30,(35)(36)(37)(38)(39)(40)(41)(42)51). For 11 cases, long-time consequences were not noted.…”

Section: Discussionmentioning

confidence: 99%

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: 99%

Pituitary adenoma apoplexy in pregnancy: Case report and literature review

Pop¹,

Ilian

Georgescu

et al. 2022

Exp Ther Med

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“…In patients with characteristic presentation and history of prolactinoma, the rapid identification of pituitary apoplexy with pituitary MRI or CT with contrast is key to determining appropriate treatment (107,108). Pituitary apoplexy can be precipitated by physiologic enlargement of the pituitary in pregnancy and prophylactic anticoagulation from history of deep vein thrombosis (109,110). In its most serious presentation, patients may have headache and visual changes accompanied by hypopituitarism.…”

Section: Evaluation Of Primary and Secondary Headachesmentioning

confidence: 99%

Headaches in Pregnancy and Postpartum

2022

Obstetrics &Amp; Gynecology

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PURPOSE:To provide updated evidence-based recommendations for the evaluation and treatment of primary and secondary headaches in pregnancy and postpartum.TARGET POPULATION:Pregnant and postpartum patients with a history of or experiencing primary or new secondary headaches.METHODS:This guideline was developed using an a priori protocol in conjunction with a writing team consisting of two specialists in obstetrics and gynecology appointed by the ACOG Committee on Clinical Practice Guidelines–Obstetrics and one external subject matter expert. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements.RECOMMENDATIONS:This Clinical Practice Guideline includes recommendations on interventions to prevent primary headache in individuals who are pregnant or attempting to become pregnant, postpartum, or breastfeeding; evaluation for symptomatic patients presenting with primary and secondary headaches during pregnancy; and treatment options for primary and secondary headaches during pregnancy and lactation. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.

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“…Pituitary apoplexy occurs when the pituitary gland develops an infarct or hemorrhage. This occurs most commonly when there is an underlying tumor or adenoma, which may be asymptomatic . Pituitary apoplexy is a rare cause of headache but it can have potentially serious outcomes if not found and treated adequately.…”

Section: Discussionmentioning

confidence: 99%

“…Although movement and physical activity can exacerbate migraine pain, these factors were particularly notable in our patient and may, in retrospect, have suggested a secondary cause of headache. Headache in pituitary hemorrhage is felt to be multifactorial, due to increased volume within the sella region, meningeal irritation, stretching of the dura, and/or trigeminal nerve involvement inside the cavernous sinus . Pituitary apoplexy is a rare but important and potentially life‐threatening differential to consider in someone presenting with new onset severe headaches.…”

Section: Discussionmentioning

confidence: 99%