Endocrine Abstracts

Introduction: Pituitary apoplexy is a serious medical complication of a pre-existing pituitary adenoma characterized by a variety of clinical symptoms ranging from mild headache to neurologically impaired and finally comatose patients.

Case report : We report a case of apoplexy in a large prolactinoma resulting in empty sella syndrome with a successful pregnancy. Our patient is a 31-year-old female, with a history of macroprolactinoma for approximately 7years. Who presented to our hospital with a history of severe headache, vomiting and visual disorders, she was pregnant in 24 weeks of amenorrhoea. The magnetic resonance imaging (MRI) was in favor of a stroke of the pituitary macro-adenoma. The hormonal exploration finds a corticotropic and thyrotropic insufficiency. A trans-sphenoid aspiration excision of the pituitary adenoma was performed urgently. MRI of control showed: total decompression of the optic chiasma. The patient had no further complaints during the pregnancy and at 38 weeks gestation she delivered a healthy baby.3months after delivery (7months after pituitary apoplexy), the pregnancy test was positive. An MRI was repeated which showed empty sella syndrome. The decision was to discontinue cabergoline and follow the patient regularly until delivery. The MRI was repeated and showed the same findings with a normal visual field test. The hormonal exploration showed nor mal thyrotropic function despite the withdrawal of substitution (the patient had stopped), and she still asymptomatic with a minimal dose of Hydrocortisone (5mg). This findings led us to discuss the recovery of hypothalamic pituitary axis ?. The hormonal tests are reported after delivery because our patient is currently pregnant in the first trimester.

Discussion: Pituitary apoplexy is a very rare cause of sudden headache in pregnancy and should be considered a medical emergency because of possible hormonal insufficiency. Surgery can significantly improve headache and both the endocrine and neuro-ophthalmic outcomes. Patients with severe neuro-ophthalmological deficits treated with early surgery can achieve an excellent recovery.

Keywords : Prolactinoma-Pregnancy-Pituitary apoplexy-Recovery