Treatment and therapeutic strategies for pituitary apoplexy in pregnancy: a case series (original) (raw)
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A case of pituitary apoplexy in pregnancy
Endocrinology, Diabetes and Metabolism Case Reports, 2014
Summary Pituitary apoplexy is a rare event in pregnancy. A 41-year-old woman with a known pituitary microadenoma presented with visual disturbance and headache during the second trimester of pregnancy. Magnetic resonance imaging (MRI) demonstrated pituitary apoplexy with chiasmal compression. After treatment with corticosteroid therapy, she underwent transsphenoidal excision of the pituitary adenoma. Visual abnormalities were completely restored and pituitary function preserved. There was no evidence of impact on the foetus. The literature on the subject is reviewed with emphasis on the management of the apoplectic patient with mild and stable neuro-ophthalmological signs. Learning points There are no clear guidelines on the management of pituitary apoplexy in pregnancy. A multidisciplinary approach can minimise morbidity and mortality. Pituitary apoplexy has an unpredictable clinical course and determining which clinical situations warrant early surgery needs to take into considera...
Pituitary apoplexy developing during pregnancy: escape from the verge of death
Clinical and Experimental Obstetrics & Gynecology, 2020
Objective: Pituitary apoplexy during pregnancy is extremely rare. Hypofunction of multiple glands due to pituitary hormone deficiency can be life threatening for the fetus and mother. A poorly functioning pituitary gland presents a variety of neurological and endocrinological symptoms, making it difficult to diagnose. The authors present a case of pituitary apoplexy in a 24-week pregnant woman who was not previously diagnosed with pituitary adenoma. Case Report: A 26-year-old woman who was 24 weeks into her first pregnancy presented with pituitary apoplexy, which included symptoms of increasing headache, nausea, vomiting, visual disturbances, and hypotensive attacks. With a multidisciplinary approach involving the departments of neurosurgery, endocrinology, gynaecology, and obstetrics, the patient underwent rapid replacement therapy and pituitary tumour excision. Pregnancy ended at the 39 th week without any feto-maternal complication. Conclusion: Pituitary apoplexy developing during pregnancy is rare and, difficult to diagnose, and requires a multidisciplinary approach to achieve a successful outcome.
Pituitary apoplexy in pregnancy: A case series and literature review
Obstetric Medicine, 2015
Background Severe headache during pregnancy is a challenging condition that may rarely imply endocrine disturbances. Rapid recognition of pituitary apoplexy is needed to improve pregnancy outcome. Objective To review and compare maternal and fetal outcomes after pituitary apoplexy. Methods Four cases of pituitary apoplexy during pregnancy in our centre are reported and literature review covering the past 54 years was performed. Results In the four cases presented and the 33 reported in the literature, most women presented with severe headaches and systemic symptoms. Overall, 42% were treated surgically, 31% received bromocriptine or cabergoline and 61% were given hormone replacement. No major obstetrical complication was reported and all babies were healthy. Conclusion Pituitary apoplexy is a rare cause of sudden and severe headache during pregnancy. Rapid identification of this condition with potentially associated endocrine disturbances is important to ensure maternal and fetal we...
Recurrent pituitary apoplexy in pregnancy
BMJ Case Reports, 2021
Pituitary apoplexy is caused by haemorrhage or infarction of the pituitary gland. Presenting signs and symptoms often include severe headache, visual disturbance, ophthalmoplegia, altered consciousness and impaired pituitary function. The management of pituitary apoplexy has very rarely been described during pregnancy and there is no existing data for further pregnancies of affected women. We present a case of a woman with a recurrent pituitary apoplexy due to haemorrhages in a pituitary adenoma in her third and fourth pregnancies. In both pregnancies, the pituitary apoplexy was managed conservatively, but due to therapy-resistant headaches, a preterm delivery was implemented.
Gestational pituitary apoplexy: Case series and review of the literature
Journal of Gynecology Obstetrics and Human Reproduction, 2019
Pituitary apoplexy is originating from Greek means "sudden attack"withhaemorrhage and/ or infarction in pituitary tumor or, less commonly, the surrounding normal gland tissue. The first index case was, described by Bailey, in 1898 [1].The true incidence and prevalence of pituitary apoplexy is difficult to establish either because the majority of the studies are retrospectives or because the diagnosis of pituitary apoplexy is usually misdiagnosed. It seems to occur in 0.65-10.5%; this proportion increases up to 25 % of surgical series [2]. Apoplexy represents the first clinical manifestation of previously unknown pituitary adenoma in 60% to 80% of cases [3-5]. It remains the rare problems that is diagnostically and therapeutically challenging. The clinical spectrum of presentation does vary, commonly characterized by sudden and severe onset of cephalalgia, nausea, vomiting, visual disturbance, and decreased consciousness. The precise physiopathology is not completely clear. Although in most cases it occurs spontaneously, pituitary apoplexy can be precipitated by many risk factors such as hypertension, medications, major surgeries, coagulopathies, dynamic testing of the pituitary, or pregnancy [4] However, pituitary apoplexy is a rare event during pregnancy, and few cases have been reported to date. It is potentially life-threatening endocrine emergency to booth the mother and the fetus, if misdiagnosed. Case 1: A 32-year-old woman was admitted to at 37-weeks gestation (WG) because of, episodes of severe fronto-orbital headache with sudden blurring of vision, since the second trimester of pregnancy (at 20 weeks of gestation). Our patient had no comorbidities. The gravida 2, para 2, abortions 0 (G2P2A0) woman, had no history of preeclampsia or other pregnancy related complications. There was no trauma or loss of consciousness. She denied any prior similar episodes or history of migraine headache. She had no associated fever, chills, no neck pain. She has a low blood pressure at 9/6 mm Hg and the physical exam was otherwise normal. Glasgow coma score scale was 15/15. Cranial nerves were grosslyintact, extra-ocular movements were intact, and no nystagmus was noted. A complete neurological examination
Challenges of Pituitary Apoplexy in Pregnancy
Journal of Clinical Medicine
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, crania...
Pituitary apoplexy during pregnancy: a rare, but dangerous headache
Journal of Endocrinological Investigation, 2014
Pituitary apoplexy is a rare endocrine emergency that occurs in a small number of patients with a pituitary tumor. It is a clinical syndrome characterized by the sudden onset of headache, nausea, vomiting, visual impairment, and decreased consciousness, caused by hemorrhage and/or infarction of the pituitary gland. Pituitary apoplexy has very rarely been described during pregnancy, when it is potentially life-threatening to both the mother and the fetus, if unrecognized. Only a few cases have been published to date. The review of the existing literature underlines that pituitary apoplexy, although rare, should be borne in mind when a pregnant woman presents with severe headache and visual defects of sudden onset. After initial management, which includes intravenous glucocorticoid therapy, fluid and electrolyte replacement, the final selection of medical or surgical treatment should result from a multidisciplinary approach involving expert specialists, keeping into account both severity of clinical presentation and gestational week.
Indian Journal of Case Reports
Headache during pregnancy is a common complaint in the emergency room. In pregnancy, pituitary disorders include both hormone active and hormone inactive tumors. Apoplexy may be the first clinical presentation of an underlying pituitary tumor. Red flag signs of presenting symptoms, to be assessed for identifying life-threatening etiology. Various pathophysiological mechanisms have been passed for pituitary apoplexy in pregnancy. Magnetic resonance imaging of the brain is the gold standard investigation. The mainstay of management is the initiation of steroids. Transnasal transsphenoidal removal of the tumor is the definitive treatment that requires a multidisciplinary approach. The indications of surgery are the presence of symptoms due to compression and endocrine abnormalities; however, gestational period should be taken into consideration. We report a case of headache in antenatal women who presented to our emergency room diagnosed with pituitary apoplexy managed with steroids an...
Surgery Research and Practice, 2014
Pituitary apoplexy is an uncommon phenomenon typically characterized by vascular insufficiency or acute hemorrhage into a pituitary adenoma. The overall incidence of pituitary apoplexy ranges between 1 and 25% of all pituitary adenomas. With the widespread use of MRI technology, the diagnosis of asymptomatic intratumoral hemorrhage is closer to 10%. The authors report a case of a 27-year-old female in her 36th week of pregnancy who presented with severe onset headache and acute left-sided vision loss. MRI of the brain revealed a large hemorrhagic mass occupying the sella turcica. The patient underwent an emergent endoscopic endonasal transsphenoidal resection for pituitary apoplexy. Postoperatively, the patient's neurologic deficit resolved. Minimally invasive endoscopic endonasal transsphenoidal resection of pituitary apoplexy can be safely utilized in third trimester pregnant women presenting with acute severe neurologic deficits.