Abstract
BackgroundPregnancy is a known risk factor for pituitary apoplexy, which is life threatening for both mother and child. However, very few clinical interventions have been proposed for managing pituitary apoplexy in pregnancy.Case presentationWe describe the management of three cases of pituitary apoplexy during pregnancy and review available literature. Presenting symptoms in our case series were headache and/or visual disturbances, and the etiology in all cases was hemorrhage. Conservative therapy was followed until 34 weeks of gestation, after which babies were delivered by cesarean section with prophylactic bolus hydrocortisone supplementation. Tumor removal was only electively performed after delivery using the transsphenoidal approach. All three patients and their babies had a good clinical course, and postoperative pathological evaluation revealed that all tumors were functional and that they secreted prolactin.ConclusionsAlthough the mechanism of pituitary apoplexy occurrence remains unknown, the most important treatment strategy for pituitary apoplexy in pregnancy remains adequate hydrocortisone supplementation and frequent hormonal investigation. Radiological follow-up should be performed only if clinical symptoms deteriorate, and optimal timing for surgical resection should be discussed by a multidisciplinary team that includes obstetricians and neonatologists.
Highlights
Pituitary apoplexy (PA) is a rare but potentially lifethreatening condition caused by rapid enlargement of a pituitary adenoma secondary to intratumoral hemorrhage and/or infarction [1,2,3]
Pregnancy increases the risk of PA, and PA in a pregnant woman is associated with significant risk of death for both mother and child
The neonatology treatment team recommended waiting for 1 week before performing a cesarean section with a prophylactic bolus supplementation of hydrocortisone, and this approach resulted in the birth of a healthy child
Summary
The underlying mechanism of PA development remains unknown, the most important treatment option for PA in pregnancy remains adequate hydrocortisone supplementation and frequent hormonal work-up. Radiological follow-up should be performed only if clinical symptoms deteriorate. The optimal time for surgical resection should be discussed in a multidisciplinary team comprising obstetricians and neonatologists
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