Delayed identification of massive pituitary apoplexy in pregnancy: A case report

Sedai, Hari; Shrestha, Suraj; Poddar, Elisha; Sharma, Pratima; Dahal, Dipendra; Khatiwada, Prajwal; Pradhananga, Amit K.

doi:10.1016/j.ijscr.2022.107706

Cited by 2 publications

(14 citation statements)

References 28 publications

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“…Headache was often accompanied by nausea and vomiting [20,64,74,81,83,86,87,91,92]. Projectile vomiting was also observed [92].…”

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

confidence: 99%

“…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]. A total of seven females had previous deliveries [20,74,75,81,84,88,90].…”

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%

“…Other frequent symptoms were visual symptoms. Visual disturbances decreased visual acuity [74,77,81,84,92], varying from visual blur [64,74,77,81] to the transient loss of vision [74] and visual field defects [20,68,69,71,77,79,80,82,85,88,90], including hemianopia [66,69,75,88,90] and unilateral vision loss [68,71,80,90]. Repetitive flashes of light were also reported [86].…”

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

confidence: 99%

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Challenges of Pituitary Apoplexy in Pregnancy

Gheorghe

Trandafir

Stanciu

et al. 2023

JCM

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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.

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“…Headache was often accompanied by nausea and vomiting [20,64,74,81,83,86,87,91,92]. Projectile vomiting was also observed [92].…”

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

confidence: 99%

Section: Patients' Characteristics: Pregnancy Featuresmentioning

confidence: 99%

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

confidence: 99%

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

confidence: 99%

See 2 more Smart Citations

Challenges of Pituitary Apoplexy in Pregnancy

Gheorghe

Trandafir

Stanciu

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…The current data suggest that conservative and surgical treatments have limited effects on delivery and fetal welfare. Although the long-term outcomes are not extensively documented, complete restoration of pituitary function is infrequent, potentially leading to a requirement for extended hormone replacement therapy in some individuals [1,16,43,44].…”

Section: Pituitary Apoplexy and Pregnancymentioning

confidence: 99%

A Narrative Review on Neuro-Ophthalmological Manifestations That May Occur during Pregnancy

Anton,

Bogdănici,

Branișteanu

et al. 2024

Life

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Aim: As a medical condition, pregnancy mandates the simultaneous treatment of both the mother and the fetus, making it a distinctive aspect of clinical medicine. Material and Method: We analyze the physiological changes occurring in the eyes and brain during pregnancy, as well as the neuro-ophthalmological manifestations that can occur during pregnancy. Studies published in both English and other languages, case reports, and reviews from 2011 to 2023 onwards were included. All surveys were acquired by exploring the databases. Results: We found a total of 2135 articles that showcase neuro-ophthalmic changes related to pregnancy: review and research articles (Science Direct 804, Web of Science 923, Scopus 345, and 63 Pub Med). In total, 86 studies were examined after applying the inclusion and exclusion criteria. Bilateral papilledema can be a warning sign for intracranial hypertension or cerebral venous sinus thrombosis. Additionally, when unilateral, it is important to differentially diagnose anterior ischemic optic neuropathy secondary to a hypercoagulant, compressive or inflammatory optic neuropathy, optic neuritis, or even orbital pseudotumor state. Severe eclampsia and preeclampsia can manifest as choroidal infarction, serous retinal detachment, and even cortical blindness. There can also be implications at the level of cranial nerves or transient Horner syndrome. Conclusions: Evaluating and treating a pregnant woman with neuro-ophthalmological manifestations is challenging. The obstetrician closely follows and has a medical relationship with the pregnant woman; hence he/she might be the first to be informed about the general condition of the pregnant woman or might request an ophthalmologic examination tailored to each specific case.

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Delayed identification of massive pituitary apoplexy in pregnancy: A case report

Cited by 2 publications

References 28 publications

Challenges of Pituitary Apoplexy in Pregnancy

Challenges of Pituitary Apoplexy in Pregnancy

A Narrative Review on Neuro-Ophthalmological Manifestations That May Occur during Pregnancy

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