Endocrine Abstracts

Introduction

Pituitary apoplexy is a rare condition which may cause death of the patient in severe cases and many times leads to hypopituitarism. It results from haemorrhagic infarction of a pre-existing pituitary adenoma or within a physiologically enlarged gland .

Case report

Our patient is a 31-year-old female, with a history of macroprolactinoma for approximately 7 years . Who presented to our hospital with a history of severe headache, vomiting and visual disorders, she was pregnant in 24 weeks of amenorrhea. The magnetic resonance imaging (MRI) was compatible with apoplexy adenoma. The hormonal exploration finds a corticotropic and thyrotropic insufficiency and the prolactin level was 1048 ng/ml. After treatment with corticosteroid therapy, she underwent transsphenoidal excision of the pituitary adenoma. The condition of the patient improved within a few days. The patient had no further complaints during the pregnancy and at 38 weeks gestation delivered a healthy baby. And 3 months later, she became pregnant. An MRI without contrast was performed in 12 weeks of amenorrhea, which showed empty Sella syndrome. The decision was to discontinue cabergoline, and follow the patient regularly until delivery. A repeated MRI with contrast was performed after delivery which showed empty Sella syndrome.

Conclusion

This case shows an unusual course of a large prolactinoma following pituitary tumor apoplexy with resolution of the pituitary tumor. She had a successful pregnancy, and after delivery there was no regrowth of the pituitary adenoma.

Keywords : prolactinoma, apoplexy, pregnancy, empty sella syndrome.