SAT-485 Transient Vision Loss Due to Physiologic Pituitary Enlargement during Normal Pregnancy

Abstract

Background: It is well know that the pituitary gland can naturally enlarge during a normal pregnancy due to hyperplasia of lactotroph cells. However, vision loss during pregnancy due to enlargement of the pituitary gland is extremly rare. Case Report: A 23 year old, gravida 10, para 1-0-8-1, female with a history of , Ehlers-Danlos, PCOS, , status post C-section at 38 and 0/7 weeks presented to the hospital with transient loss of left sided vision for 30 minutes, which then fully resolved. She denies any previous complaints of vision loss prior to pregnancy. . The patient denied any headache, problems swallowing, history of ophthalmoplegia difficulties with speech, vertigo, lightheadedness, or any focal weakness, numbness, or tingling in her arms or legs. She reported a similar event happening the month prior while pregnant and MRI of the brain without contrast at that time showed an enlargement of the pituitary gland. Series of subsequent imaging showed no evidence of dural venous sinus thrombosis, an unremarkable intracranial and neck MRA, but was positive for diffuse pituitary gland enlargement measuring approximately 1.1 x 1.0 cm. The pituitary gland was seen extending cephalad above the sella turcica contacting the left side of the optic chiasm similar appearance compared to the MRI one month prior. The patient returned to baseline and was advised to follow up with outpatient ophthalmology for visual field testing. Interpretaion : During pregnancy, the normal pituitary gland enlarges considerably, due to the estrogen-stimulated lactotroph hyperplasia; on magnetic resonance imaging (MRI) scans the peak size of up to 12 mm occurs in the first few days Postpartum.Differential diagnosis of pituitary enlargement during pregnancy can be difficult since MRI is not specific to each condition. Pituitary adenoma can be ruled out due to the quick recovery postpartum and the patient’s lack of other symptoms. Prolactinoma can be determined by finding elevated prolactin levels during pregnancy, which is common. Granulomatous hypophysitis due to sarcoidosis and lymphocytic hypophysitis can be ruled out due to the patient’s negative history for autoimmune diseases. Definitive diagnosis of this patient would be to undergo neurosurgical procedure, which would not be reasonable in this case since visual loss was mild and the patient returned to baseline. Management of conscious patient with mild visual disturbances is still debatable. Some investigators argue early surgical intervention to prevent permanent visual loss and/or preserve pituitary function.patient follow up MRI post Pregnancy showed decrease in size of the enlarged pituitary gland Conclusion: Physiologic enlargement of Pituitary sholud be included in differential diagnosis of Transient Visual loss during late pregnancy . 1. Loss of vision due to a physiologic pituitary enlargement during normal pregnancy. Clin Exp Opthalmol 245: 1049-1051