Pituitary Apoplexy and Subdural Hematoma after Caesarean Section

Hoang, Van Trung; Hoang, The Huan; Nguyen, Thi Tan; Chansomphou, Vichit; Hoang, Thanh D.

doi:10.1155/2022/3097949

Cited by 2 publications

(12 citation statements)

References 25 publications

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“…The mean age of patients who suffered PA in PP was 33 years. Three patients were in their second pregnancies, two patients were prim gravidae [93,[95][96][97], and one female was G4P1A3 [20]. Overall, 4/6 individuals had CS, 2/6 had VD (including one that was homeconducted) [20,[93][94][95][96][97].…”

Section: Pa During Ppmentioning

confidence: 99%

“…Six cases of PA in PP state were identified during our search [20,[93][94][95][96][97]. The findings are summarized in (Table 3; one study being also cited in Tables 1 and 2-please see reference [20]).…”

Section: Pa During Ppmentioning

confidence: 99%

“…Three patients were in their second pregnancies, two patients were prim gravidae [93,[95][96][97], and one female was G4P1A3 [20]. Overall, 4/6 individuals had CS, 2/6 had VD (including one that was homeconducted) [20,[93][94][95][96][97]. The timing of symptoms was as early as 5 min after delivery [93] and as late as 12 days after delivery [95], including 3/6 females with PA 2 days following delivery [94,96,97].…”

Section: Pa During Ppmentioning

confidence: 99%

“…In one study, 5/6 subjects had no underlying pituitary adenoma [20,[93][94][95][96]. Pop et al reported a non-functioning large pituitary adenoma of 3.3 × 1.05 × 1.55 cm that was undiagnosed before pregnancy [97].…”

Section: Pa During Ppmentioning

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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Section: Pa During Ppmentioning

confidence: 99%

Section: Pa During Ppmentioning

confidence: 99%

Section: Pa During Ppmentioning

confidence: 99%

Section: Pa During Ppmentioning

confidence: 99%

See 2 more Smart Citations

Challenges of Pituitary Apoplexy in Pregnancy

Gheorghe

Trandafir

Stanciu

et al. 2023

JCM

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“…The MRI revealed pituitary apoplexy and left frontal subdural hematoma. Subsequently, The patient was treated conservatively, and ultimately in the follow, laboratory tests and imaging exams to check pituitary function did not reveal any abnormalities (11).…”

mentioning

confidence: 99%

A right-sided subdural frontoparietal hemorrhage in a patient after spinal anesthesia for cesarian section surgery. Case report

Shoja,

Zandi,

soufizadeh

et al. 2023

Preprint

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Background : Peridural and subdural hemorrhage are rare but important complications after regional anesthesia.Case presentation: A 29 year old female gravid 1, para 1, with a history of cesarian section, was admitted for headache exacerbation. The patient received spinal anesthesia. The patient didn't have any specific disease or previous headache. The drug history was negative except for routine pregenetic drugs. Although, at the time of Spinal anesthesia, the patient was slightly nervous. All previous pre-operation tests and exams were normal. The patient experienced a mild headache a day after the surgery; adequate liquid intake was recommended. The patient was discharged 48 hours after the surgery. Furthermore, after about a week, the patient contacted her primary physician for exacerbated headache. The physician recommended her liquid intake, rest, and proper analgesia. Ten days after surgery, the patient visited a clinic for an excruciating headache with vomiting. Therefore, the patient was admitted emergently. The neurosurgery consult and Magnetic Resonance Imaging (MRI) scan was performed. A subdural frontoparietal hemorrhage on the right side was diagnosed. The patient's hematoma was drained emergently afterward. The patient was discharged four days after the drainage surgery without neurological complications. Conclusion:Peridural and subdural hemorrhages are rare complications of spinal anesthesia that can be lethal. The chief complaint of this complication is headache. It is essential to keep this complication in mind for patients experiencing headaches after spinal anesthesia surgeries.

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Pituitary Apoplexy and Subdural Hematoma after Caesarean Section

Cited by 2 publications

References 25 publications

Challenges of Pituitary Apoplexy in Pregnancy

Challenges of Pituitary Apoplexy in Pregnancy

A right-sided subdural frontoparietal hemorrhage in a patient after spinal anesthesia for cesarian section surgery. Case report

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