Concomitant Pituitary Apoplexy and Acute Fatty Liver of Pregnancy: About A Case with Review of the Literature

Abstract

Pituitary complications during childbirth have become relatively rare in developed countries. In this case report, we report a case of panhypopituitarism complicating postpartum acute liver failure. We also review the current literature on cases of pituitary hormone deficiencies associated with acute statosis of pregnancy. 26-year-old patient, pregnant at 37 weeks of amenorrhea, admitted for jaundice with abolition of fetal movements, ultrasound showed a monofetal pregnancy corresponding to the gestational age with absence of any cardiac activity, the initial assessment showed a hepatic cytolysis, hepatic cholestasis, renal insufficiency and oliguria, hemostasis abnormalities, abdominal ultrasound had objectified a hyper echogenic liver suggesting fatty infiltration, After induction of labor and vaginal delivery of a stillborn, the postpartum was marked by the presence of uterine hemorrhage despite the presence of a good safety globe responsible for a state of shock with hypotension requiring the administration of vasoactive drugs, the patient had received several massive transfusions. evolution was marked by the improvement of the hemodynamic state, regression of hepatic cytolysis, improvement of hemostasis, Subsequently the patient reported headaches, abdominal pain, an absence of milky rise and a tendency to hypoglycemia, the hypophysiogram objectified a pituitary insufficiency raising suspicion of the diagnosis of pituitary necrosis which was confirmed by the realization of cerebral magnetic resonance imaging. The presence of risk factors such as peripartum bleeding and disseminated intravascular coagulation secondary to hepatic steatosis acute pregnancy seems to be a risk factor for the occurrence of pituitary apoplexy.