Endocrine Abstracts

Introduction: Pituitary apoplexy is a rare syndrome due to hemorrhagic infarction of a pituitary adenoma. It may be clinically overt (sudden, severe headache, visual disturbances, impairment in pituitary function, and altered consciousness), or subclinical. Pregnancy is a rare predisposing factor, which may raise difficulties in the diagnosis and treatment.

Case presentation: A 25 years woman diagnosed with a 1/0.8 cm prolactinoma, initial serum PRL 61.5 ng/ml (normal 1.3–24.2), without macroprolactin, in whom menses recovered only after increasing cabergoline (CAB) treatment to 1.5 mg/week. After 1 year PRL was 20.7 ng/ml, the tumor size was stable (1.1/0.9 cm) and the patient got pregnant. In the 8th week of pregnancy the patient developed a transient right-sided headache for 2 weeks. CAB was gradually tapered to 0.25 mg/week then withdrawn in the 9th month of pregnancy. Six months after delivery PRL=59 ng/ml, tumor size was increased 1.46/0.9 cm. CAB was re-started, 3 mg/week being needed to normalize PRL. The patient got a second pregnancy, while PRL was 29.1 ng/ml and the tumor 1.24/0.94 cm. In the 8th week of pregnancy a severe frontal headache associated with fatigue and nausea, but a not visual defect, occurred for 1 week during an upper respiratory viral infection, and was ameliorated with acetaminophen. Morning serum cortisol, TSH, and FT₄ were normal. CAB was tapered and withdrawn after the 31st week of pregnancy. Three months after delivery PRL was 59.6 ng/ml and MRI showed a 1.8/1.3 cm pituitary tumor with a fluid collection suggesting a tumor haemorrhage in a late subacute stage. CAB 2 mg/week was initiated and, despite another transient 3 h-severe headache, the tumor decreased to 1/1 cm, with no visual or pituitary function defects.

Conclusion: Although a rare event, pituitary apoplexy should be considered when severe headaches occur during pregnancy in a woman with a pituitary adenoma.