Endocrine Abstracts

Pituitary apoplexy is a rare but life threatening condition if not diagnosed and treated promptly. Common causes include hypertension, head trauma, major surgery, dynamic pituitary tests, anticoagulant use and pregnancy. In pregnancy, hyperplasia and hypertrophy of the lactotroph cells increase pituitary volume by 45% returning to original size at 6 months post-partum. Pituitary apoplexy is uncommon in pregnancy and an underlying adenoma is usually the cause. Very few case reports mention pituitary apoplexy due to physiological enlargement in pregnancy. We describe a similar case here. A 30-year-old primi-gravida presented to the Ambulatory Clinic in her 26th week of gestation with a significant dull central headache for the previous three days. There was no past medical history of note and she was only taking folic acid. There was no family history of hypertension, polycystic kidney disease or Berry aneurysms. There were no signs of meningeal irritation with normal visual fields to confrontation. Her blood pressure was 135/75 mmHg. An MRI/MRV brain revealed an 8 mm(8 mm intra-glandular pituitary bleed in T1-weighted images with no compression of the optic apparatus. Further work-up revealed plasma Cortisol 420 nmol/l, TSH 1.88 mIU/l, fT4 11.2 pmol/l and Prolactin 424 mIU/l. She was closely followed up in endocrine clinic and delivered a healthy baby at completion of gestation. A repeat MRI pituitary post-partum showed a small reduction (8 mm×7 mm) in the bleed and her biochemistry and endocrine profile remained unremarkable. This case highlights a rare condition during pregnancy which can be detrimental with poor maternal and foetal outcomes. Headache (94%), visual field defects (47%) and nausea and/or vomiting (41%) are the most common clinical features of pituitary apoplexy. This should remain in the differential diagnosis for a physician when a pregnant lady presents with above and should lead to prompt investigations and treatment. A multidisciplinary approach provides the best care in such patients.