Management of pituitary adenoma with mass effect in pregnancy: a case report

Okafor, Ugochukwu Vincent; Onwuekwe, Ikenna; Ezegwui, HU

doi:10.4076/1757-1626-2-6350

Cited by 7 publications

(7 citation statements)

References 6 publications

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“…A 30-year-old patient diagnosed with pituitary adenoma at 24 weeks of gestation was prescribed bromocriptine with a plan for a postnatal neurosurgery. Following a preterm delivery at 35 weeks through Caesarean section she developed hypertension, acute encephalopathy and fatal cardiac arrest on day three postpartum (21).…”

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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“…Moreover, dopamine agonist therapy has been considered a risk factor for pituitary apoplexy and bromocriptine has been associated with hypertension, cardiac injury, and death when used in the postpartum period in a 30-year-old nulliparous Nigerian woman. [13] Interestingly, except for hirsutism, she was completely asymptomatic before this pregnancy. Moreover, she complained of oligomenorrhea before the first pregnancy which spontaneously resolved after giving birth.…”

Section: Discussionmentioning

confidence: 94%

Large Nonfunctioning Pituitary Adenoma Presenting with Visual Loss During Late Pregnancy—Challenges in Management

Terhes

Baciu

Curt

et al. 2019

SN Compr. Clin. Med.

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Nonfunctioning pituitary adenomas (NFPA) are very rare during pregnancy since fertility is usually impaired. A 31 year old hirsute woman was referred to the Endocrine Clinic for a large pituitary tumor, discovered at 35 weeks of gestation. She complained of increasing headache and abnormal vision, particularly in her left eye in the previous few weeks. An MRI scan showed a pituitary mass: 3.1 ×2.7 ×1.8 cm (LL/CC/AP) with suprasellar extension, and compression of the optic chiasm. Serum prolactin and the results of other endocrine investigations were normal, so she was diagnosed with NFPA. Both inducing labour or medication (bromocriptine) administration while proceeding to a safe term for pregnancy were considered. However, we chose to only follow her closely. There was no further deterioration and, at 38 weeks, a caesarian section was performed and a healthy boy was delivered. Two weeks after delivery, she underwent craniotomy (by right lateral subfrontal approach) with resection of the NFPA, followed by complete regression of the visual disturbances. The postoperative MRI demonstrated empty sella and no residual tumor, while the hormonal evaluation detected no significant pituitary insufficiency. Although cost-effective, combined histologic and immunophenotypic studies, especially extended IHC tests, can reduce the incidence of misdiagnosed large-cell lymphoma. As exemplified in this present case, obtaining appropriate and sufficient tissue from the tumor could possibly increase the chance of finding an accurate diagnosis.

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“…Profound postpartum hypotension is compounded by pituitary gland expansion of up to 136% by late pregnancy 7. Increase in size and associated changes in vascular supply and permeability may similarly precipitate haemorrhagic infarction during the antepartum period;5 8 however, these sequelae are rare and have only been documented in case reports 4 9…”

Section: Discussionmentioning

confidence: 99%

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

Watson¹

2015

BMJ Case Reports

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Pituitary apoplexy is a rare event in which the pituitary gland undergoes infarction or haemorrhage, most commonly in the setting of an underlying tumour. We report on apoplexy of an undiagnosed pituitary adenoma precipitated both by physiological enlargement of the pituitary in pregnancy and prophylactic anticoagulation from a history of deep vein thrombosis. The haemorrhage was managed conservatively without significant complications.

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Management of pituitary adenoma with mass effect in pregnancy: a case report

Cited by 7 publications

References 6 publications

Pituitary adenoma apoplexy in pregnancy: Case report and literature review

Pituitary adenoma apoplexy in pregnancy: Case report and literature review

Large Nonfunctioning Pituitary Adenoma Presenting with Visual Loss During Late Pregnancy—Challenges in Management

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

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