Context: Prolactinoma is the most frequent pituitary tumor among women of childbearing age. Fewer studies have addressed the outcome of prolactinomas after gestation. Objective: The aim was to study the spontaneous remission rate and change in tumor size after pregnancy and/or lactation in women with prolactinomas. Patients and Methods: Retrospective study conducted at a tertiary care center of north India. Records of 25 women with 31 pregnancies (20 microprolactinomas and 11 macroprolactinomas), who conceived on dopamine agonist (cabergoline) were studied. Cabergoline was stopped at conception in 24 pregnancies and continued in 7. Serum prolactin was noted 3 months after delivery and/or lactation. Magnetic resonance imaging available at last visit after delivery and/or lactation was also noted. Remission was defined as normal serum prolactin after pregnancy and/or lactation without use of cabergoline. Results: Among patients in whom cabergoline was stopped during pregnancy (n = 24), 41.6% (n = 10) had prolactin in normal range (achieved remission) after pregnancy and/or lactation. In 25% (n = 6) of women, adenoma size decreased by more than 50%, in 33%(n = 8), there was no change in adenoma size, and in 42% (n = 10), decrease in adenoma size was less than 50% after pregnancy and/or lactation. The median duration of cabergoline treatment before pregnancy among patients who achieved remission was 60 months against 24 months in those who did not achieve remission. The median pre-pregnancy adenoma size was 5.5 mm in women with remission against 8 mm in women who did not achieve remission. Conclusion: Pregnancy-induced remission of hyperprolactinemia was seen in 41.6% prolactinomas. Longer duration of dopamine agonist treatment before pregnancy, small pre-pregnancy adenoma size, and lower baseline prolactin were associated with high likelihood of remission, though not statistically significant.
Case 1An elderly patient presented with insidious onset of sensorineural hearing loss. The past history was unremarkable except for insidious onset of weakness of left lower limb. Physical examination revealed left hemiparesis with upgoing left plantar. Magnetic resonance imaging (MRI) of brain revealed a large flow void in the interpeduncular cistern suggestive of aneurysm arising from the top of the basilar artery. In addition, hypointense signal was noted (prominent on T2 and FLAIR images) on the surface of both cerebral hemispheres, the pons, cerebellar folia and medulla. The final diagnosis was superficial siderosis secondary to leaking basilar artery aneurysm [ Figures 1 and 2].Case 2 A middle-aged female, with complaints of progressive ataxia and bilateral sensorineural hearing loss was referred for MRI of brain. The patient had significant medical history of adult onset seizure disorder well controlled with anti-epileptic drugs. Physical examination revealed senorineural deafness and limb and gait ataxia. Computed tomography (CT) showed a small intraparenchymal hyperdense lesion in the right parietal region suggestive of hematoma. MRI of brain revealed a typical popcorn lesion in right parietal region with heterogeneous signal intensity on T1, T2 and FLAIR images with fluid levels suggestive of a cavernous angioma. In addition, hypointense signal was noted (especially on T2 images) coating the cerebral sulci, pons, midbrain and medulla. Mild cerebellar cortical atrophy was also noted [ Figures 3 and 4]. The final diagnosis was superficial siderosis secondary to cavernous malformation.Superficial siderosis is the result of chronic and recurrent subarachnoid hemorrhage and the causes include: Figure 1: Coronal T2 images show hypointense signal on the surfaces of the sulci due to hemosiderin staining
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