Pituitary Apoplexy in Pregnancy

Kanneganti, Abhiram; Lwin, Sein; Su, Lin

doi:10.1016/j.jogc.2021.04.010

Cited by 1 publication

(8 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The age at the presentation of gestational PA ranged between 21 years [90] and 41 years [69] with an average age of 27.76 years. In total, 21/44 patients presented with signs and symptoms of PA during the 3rd trimester [20,[70][71][72][73][74]76,77,[79][80][81][82][83][84][85][86][87][88][89][90][91], and 1 female was admitted for PA during the first trimester [65] (the others presented during the second trimester). The mean WG at presentation was 26.38, the earliest at 10 WG [65] and the latest at 39 WG [20].…”

Section: Patients' Characteristics: Pregnancy Featuresmentioning

confidence: 99%

“…The mean WG at presentation was 26.38, the earliest at 10 WG [65] and the latest at 39 WG [20]. Most subjects (N = 9) were prim gravidae [20,65,70,73,76,80,81,87,89]. Moreover, one patient was nulliparous [85], one was primipara [77], one was P1 [88], two were G2 [81,92], two were G3 [86,90], two were G5 [74,85], one patient was G6P3A2 [20], and one was G6P4 [75].…”

Section: Patients' Characteristics: Pregnancy Featuresmentioning

confidence: 99%

“…In total, 30/44 patients with data available regarding the method of delivery, 19/30 patients underwent a C-section (CS) [64,66,67,70,71,74,76,78,80,82,[85][86][87][88][89][90][91], and 11/30 women underwentvaginal delivery (VD) [20,65,69,73,83,84,89,90]. In addition, one subject underwent CS in both of her pregnancies [86].…”

Section: Patients' Characteristics: Pregnancy Featuresmentioning

confidence: 99%

“…In addition, one subject underwent CS in both of her pregnancies [86]. Furthermore, 32/44 patients with data available regarding WG at delivery, 25 underwent full-term delivery [20,[64][65][66][67]69,71,73,74,76,[79][80][81][83][84][85]87,88,90,91], and 7 females are mentioned to have delivered preterm babies [70,82,86,88,89]. Notably, one subject delivered preterm twins at 28 WG who died 7 days after birth [89].…”

Section: Patients' Characteristics: Pregnancy Featuresmentioning

confidence: 99%

“…Chan et al, however, described a mild headache [84]. Localization of the pain varied: fronto-parietal, fronto-orbital, temporal, and occipital were all present, as well as irradiation to the forehead [70,74,81,86,87,92]. Headache was often accompanied by nausea and vomiting [20,64,74,81,83,86,87,91,92].…”

Section: Onset Of Pa In Pregnancy: Focus On Clinical Panelmentioning

confidence: 99%

See 4 more Smart Citations

Challenges of Pituitary Apoplexy in Pregnancy

Gheorghe

Trandafir

Stanciu

et al. 2023

JCM

View full text Add to dashboard Cite

Our purpose is to provide new insights concerning the challenges of pituitary apoplexy in pregnancy (PAP) and the postpartum period (PAPP). This is a narrative review of the English literature using a PubMed search. The inclusion criteria were clinically relevant original studies (January 2012–December 2022). Overall, we included 35 original studies: 7 observational studies (selected cases on PA) and 28 case reports, including 4 case series (N = 49; PAP/PAPP = 43/6). The characteristics of PAP patients (N = 43) are as follows: maternal age between 21 and 41 (mean of 27.76) years; 21/43 subjects with a presentation during the third trimester (only one case during first trimester); average weak of gestation of 26.38; most females were prim gravidae; 19 (out of 30 patients with available data on delivery) underwent a cesarean section. Headache remains the main clinical feature and is potentially associated with a heterogeneous panel (including visual anomalies, nausea, vomiting, cranial nerve palsies, diabetes insipidus, photophobia, and neck stiffness). Pre-pregnancy medication included dopamine agonists (15/43) and terguride (1/43) in addition to subsequent insulin therapy for gestational diabetes (N = 2) and type 1 diabetes mellitus (N = 1). Overall, 29/43 females received the conservative approach, and 22/43 women had trans-sphenoidal surgery (TSS) (and 10/22 had the initial approach). Furthermore, 18/43 patients had a pituitary adenoma undiagnosed before pregnancy. Most PA-associated tumors were prolactinomas (N = 26/43), with the majority of them (N = 16/26) being larger than 1 cm. A maternal–fetal deadly outcome is reported in a single case. The characteristics of PAPP patients (N = 6) are as follows: mean age at diagnosis of 33 years; 3/6 subjects had PA during their second pregnancy; the timing of PA varied between 5 min and 12 days after delivery; headache was the main clinical element; 5/6 had no underlying pituitary adenoma; 5/6 patients were managed conservatively and 1/6 underwent TSS; pituitary function recovered (N = 3) or led to persistent hypopituitarism (N = 3). In conclusion, PAP represents a rare, life-threatening condition. Headache is the most frequent presentation, and its prompt distinction from other conditions associated with headache, such as preeclampsia and meningitis, is essential. The index of suspicion should be high, especially in patients with additional risk factors such as pre-gestation treatment with dopamine agonists, diabetes mellitus, anticoagulation therapy, or large pituitary tumors. The management is conservative in most cases, and it mainly includes corticosteroid substitution and dopamine agonists. The most frequent surgical indication is neuro-ophthalmological deterioration, although the actual risk of pituitary surgery during pregnancy remains unknown. PAPP is exceptionally reported. To our knowledge, this sample–case series study is the largest of its kind that is meant to increase the awareness to the benefit of the maternal–fetal outcomes from multidisciplinary insights.

show abstract