Pituitary injury and persistent hypofunction resulting from a peripartum non-hemorrhagic, vaso-occlusive event

Abstract

SummaryCerebral vascular accidents are caused by vasospasm when induced by preeclampsia or by dopamine agonists. However, six arteries nourish the pituitary and prevent against vasospasm-induced damage, which up until now has not been thought to occur. Bromocriptine was used to arrest lactation in a 31-year-old with secondary amenorrhea following preeclampsia and fetal demise at 28 weeks gestation. Tests and history revealed panhypopituitarism not associated with hemorrhage or mass infarction but instead caused by vasospasm. The present study is the first report of pituitary damage from a non-hemorrhagic, vaso-occlusive event in the literature. In keeping with Sheehan's and Simon's syndromes, we have named pituitary damage resulting from vaso-occlusion as Dahan's syndrome, and a literature review suggests that it may be a common and previously overlooked disorder.Learning points Vasospasm can cause damage to the pituitary gland, although it was not previously believed to do so.Preeclampsia and the use of a dopamine agonist, particularly in the peripartum state, may trigger vasospasm.Vasospasm resulting from dopamine agonists may be a common cause of injury to the pituitary gland, and it may have been overlooked in the past.

Posterior reversible encephalopathy syndrome with reversible cerebral vasoconstriction syndrome in a normal primigravida woman at the 35-week gestational stage: a case report

“…However, in the case of RCVS, antihypertensive therapy may lead to a decrease in peripheral blood flow which may contribute to cerebral ischemia, since cerebral vasoconstriction may reduce cerebral blood flow. Furthermore, one study reported the possibility of persistent pituitary damage from a peripartum non-hemorrhagic, vasoconstriction event [17]. In this case, antihypertensive treatment for intracerebral hemorrhage and diazepam therapy for treatment of seizures were administered, since the patient was already suffering from impaired consciousness due to cerebral hemorrhage, but careful treatment planning is required for each case.…”