Gestational pituitary apoplexy: Case series and review of the literature (original) (raw)

2019, Journal of Gynecology Obstetrics and Human Reproduction

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