Pituitary apoplexy during pregnancy

Chegour, H.; Ansari, N. El

doi:10.11604/pamj.2014.17.211.4133

Cited by 7 publications

(7 citation statements)

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“…Analysis of cases treated conservatively showed that this is a viable and safe option in a patient without visual field defects. Overall, in 16 cases there was full recovery of endocrinological function and in 21 cases, various degree of insufficiency ranging from diabetes insipidus to panhypopituitarism and cranial nerve palsy being encountered (4,7,9,19,24,26,29,30,(35)(36)(37)(38)(39)(40)(41)(42)51). For 11 cases, long-time consequences were not noted.…”

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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“…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%

“…Additional risk factors that have been identified are summarized in Tables 1 and 2 and include treatment with DAs (15/44), gestational DM (N = 2), type 1 DM (N = 1), and acute COVID-19 infection [20,84,86,89,90]; moreover, the case studied by Grand'Maison et al [20] suffered from both gestational DM and preeclampsia during previous pregnancies [20]. Overall, 15/44 females had previous treatment with DAs, as follows: 11/15 persons underwent cabergoline treatment [20,69,73,76,81,85,89,90], 4/15 used bromocriptine [68,71,73,90], and one woman was under terguride [88]. De Ycaza et al [73] introduced a subject switching from bromocriptine to cabergoline due to side effects; when pregnancy was confirmed, DA was stopped [73].…”

Section: Risk Factors For Developing Pa In Pregnancymentioning

confidence: 99%

“…Most patients (N = 29) received conservative management that included glucocorticoid supplementation with hydrocortisone or dexamethasone (1 case), thyroid substitution (in 3 cases) in addition to DAs; the cases with DI required desmopressin [20,64,65,67,68,73,74,[76][77][78][79]81,83,84,[86][87][88][89][90][91]. Kanneganti et al [87] reported a 26-year-old primigravida at 37 WG who was free of previous medical problems and developed headache and visual disturbance in pregnancy.…”

Section: Conservative Management Of Pa Amid Pregnancymentioning

confidence: 99%

“…Cases with prolactinomas developing PA in pregnancy seem the most frequent with regard to the type of PitNET. Chegour et al [68] reported PA in a 29-year-old woman with a macroprolactinoma unconfirmed before pregnancy, who received treatment with bromocriptine for hyperprolactinemia of uninvestigated etiology. At 19 WG, she presented with headache and visual disturbances due to PA, and she was conservatively managed with cabergoline leading to the complete regression of the visual symptoms [68].…”

Section: Conservative Management Of Pa Amid Pregnancymentioning

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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Prolactinomas in pregnancy: considerations before conception and during pregnancy

Glezer

Bronstein

2019

Pituitary

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Pituitary apoplexy during pregnancy

Cited by 7 publications

References 0 publications

Pituitary adenoma apoplexy in pregnancy: Case report and literature review

Pituitary adenoma apoplexy in pregnancy: Case report and literature review

Challenges of Pituitary Apoplexy in Pregnancy

Prolactinomas in pregnancy: considerations before conception and during pregnancy

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