Endocrine Abstracts

Pituitary apoplexy is a rare condition and gestational pituitary apoplexy (GPA) is even more exceptional. Clinical presentation of GPA is often non-specific overlapping with other conditions, making its diagnosis challenging. Additionally, therapeutic management is often limited since it depends on both the mother’s and the fetus’s prognosis. Herein we report of a woman who was diagnosed with GPA and we discuss the management of her case. A 34-year-old woman with no notable familial nor personal medical history, presented with severe headaches of sudden onset, paroxystic and holocranial associated with a blurred vision predominantly at the left eye. Her symptomatology appeared for the first time in the second trimester of her first pregnancy. Six weeks later, she consulted a neurologist. An MRI showed the presence of a pituitary macroadenoma of 21*16 mm, hyperintense T1 and hypointense T2, with hemorrhagic necrosis and abutting the optic chiasma. The patient was admitted therefore in our department of Endocrinology. Hormonal evaluation concluded to the presence of corticotropic and thyrotropic insufficiency. As hormonal changes occur in pregnancy, evaluation of secreting adenoma is mostly challenging. Nonetheless prolactin level was evaluated, demonstrating a high level of 965 ng/ml, surpassing 600 ng/ml which the maximum level of prolactin found in pregnant normal women. Thus, a substitutive treatment with levothyroxine and hydrocortisone was started. Since the patient’s neuro-ophthalmologic status was stable, urgent surgery was not indicated. Bromocriptine was prescribed to our patient at progressive doses. The evolution under treatment was marked by the relief of her headaches and the improvement of her visual acuity. The delivery was successful and the baby as well as the mother were normal. GPA is an exceptional finding. Both hormonal evaluation of hypopituitarism and hypersecreting adenomas can be challenging. Therapeutic approach depends essentially on the patient’s symptomatology and pregnancy term.