Gestational pituitary apoplexy: Case series and review of the literature

Jemel, Manel; Kandara, Hajer; Riahi, Mariem; Gharbi, Radhouane; Nagi, S.; Kamoun, Inès

doi:10.1016/j.jogoh.2019.05.005

Cited by 25 publications

(36 citation statements)

References 38 publications

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“…In most patients, the finding of any evidence of hemorrhage within the pituitary gland is in itself unlikely to meet the classification for apoplexy as hemorrhage within an incidentally discovered or even symptomatic pituitary tumor is relatively common occurring approximately 14% of cases but is not typically associated with clinical symptomatic apoplexy [11]. Apoplexy associated with a pregnancy is reported throughout the medical literature although the actual number of cases reported remains relatively small, with approximately 45 cases [4,6,7]. A review of this literature demonstrates that the majority occur in the second or third trimester, particularly the third trimester and the management of the apoplexy had relatively little impact on the delivery of the child or healthy completion of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…Apoplexy associated with a pregnancy is reported throughout the medical literature although the actual number of cases reported remains relatively small, with approximately 45 cases [ 4 , 6 , 7 ]. A review of this literature demonstrates that the majority occur in the second or third trimester, particularly the third trimester and the management of the apoplexy had relatively little impact on the delivery of the child or healthy completion of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…Theories underlying this connection include hypercoagulable state and hormonal influences due to pregnancy [5]. This exceedingly rare event has been reported less than fifty times in the gravid patient with a handful of reports [4,6,7].…”

Section: Introductionmentioning

confidence: 99%

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Pituitary apoplexy associated with acute COVID-19 infection and pregnancy

et al. 2020

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Purpose We report a case of a pregnant female presenting with pituitary apoplexy and simultaneous SARS-CoV-2 infection with a focus on management decisions. Clinical history A 28-year-old G5P1 38w1d female presented with 4 days of blurry vision, left dilated pupil, and headache. She tested positive for SARS-CoV-2 on routine nasal swab testing but denied cough or fever. Endocrine testing demonstrated an elevated serum prolactin level, and central hypothyroidism. MRI showed a cystic-solid lesion with a fluid level in the pituitary fossa and expansion of the sella consistent with pituitary apoplexy. Her visual symptoms improved with corticosteroid administration and surgery was delayed to two weeks after her initial COVID-19 infection and to allow for safe delivery of the child. A vaginal delivery under epidural anesthetic occurred at 39 weeks. Two days later, transsphenoidal resection of the mass was performed under strict COVID-19 precautions including use of Powered Air Purifying Respirators (PAPRs) and limited OR personnel given high risk of infection during endonasal procedures. Pathology demonstrated a liquefied hemorrhagic mass suggestive of pituitary apoplexy. She made a full recovery and was discharged home two days after surgery. Conclusion Here we demonstrate the first known case of successful elective induction of vaginal delivery and transsphenoidal intervention in a near full term gravid patient presenting with pituitary apoplexy and acute SARS-CoV-2 infection. Further reports may help determine if there is a causal relationship or if these events are unrelated. Close adherence to guidelines for caregivers can greatly reduce risk of infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pituitary apoplexy associated with acute COVID-19 infection and pregnancy

et al. 2020

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“…Surgical decompression via an endonasal endoscopic or a trans-sphenoidal approach is indicated if there is deteriorating consciousness or neuro-ophthalmologic deficit. 1 While normal vaginal delivery is permissible with stress dose corticosteroids, 2 the patient underwent cesarean delivery 1 week later to avoid valsalva.…”

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confidence: 99%

“…L'apoplexie hypophysaire est une cons equence rare de l'hypertrophie gestationnelle des ad enomes hypophysaires. Elle peut causer l'insuffisance hypophysaire compl ete et la c ecit e. La d ecompression chirurgicale par voie endoscopique endonasale ou par voie trans-sph enoïdale est indiqu ee en cas de d et erioration de la conscience ou de d eficit neuro-ophtalmologique 1 . Bien que l'accouchement vaginal normal soit admis avec une corticoth erapie dont la dose est adapt ee a la situation de stress 2 , la patiente a subi une c esarienne une semaine plus tard pour eviter une manoeuvre de Valsalva.…”

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