Apoplexy of A Microprolactinoma During Pregnancy: Case Report and Review of Literature

Abstract

To report a rare case of apoplexy in a microprolactinoma during pregnancy. We present the initial clinical manifestations, laboratory results, radiologic findings, and management in a patient who had pituitary apoplexy during early pregnancy. The pertinent literature and management options are also reviewed. A 37-year-old woman with a history of a microprolactinoma presented during the 16th week of her first pregnancy with a sudden onset of severe headache, nausea, vomiting, and blurred vision. Magnetic resonance imaging showed a sellar heterogeneous mass with suprasellar extension and contact with the optic chiasm, compatible with adenoma apoplexy. The patient's visual fields were normal. Conservative management was followed by rapid clinical improvement and a notable regression of the sellar mass after 5 weeks of cabergoline therapy. Uneventful pregnancy resulted in the delivery of a healthy baby. Repeated magnetic resonance imaging was performed 1 week after delivery and showed resolution of the microadenoma. At 3 months after delivery, the patient had recovered regular menses and had sustained normal prolactin levels without treatment. This case illustrates a rare occurrence of apoplexy in a microprolactinoma during pregnancy, which was managed conservatively and led to a complete regression of the pituitary tumor.