scholarly journals A case of pituitary apoplexy in pregnancy

2014 ◽  
Vol 2014 ◽  
Author(s):  
Aimee R Hayes ◽  
Anthony J O'Sullivan ◽  
Mark A Davies
Keyword(s):  
Pituitary Apoplexy ◽  
Rare Event ◽  
Visual Disturbance ◽  
List Type ◽  
The Subject ◽  
Magnetic Resonance Imaging Mri ◽  
Evidence Of Impact ◽  
Learning Points ◽  
Visual Abnormalities ◽  
In Pregnancy

Summary Pituitary apoplexy is a rare event in pregnancy. A 41-year-old woman with a known pituitary microadenoma presented with visual disturbance and headache during the second trimester of pregnancy. Magnetic resonance imaging (MRI) demonstrated pituitary apoplexy with chiasmal compression. After treatment with corticosteroid therapy, she underwent transsphenoidal excision of the pituitary adenoma. Visual abnormalities were completely restored and pituitary function preserved. There was no evidence of impact on the foetus. The literature on the subject is reviewed with emphasis on the management of the apoplectic patient with mild and stable neuro-ophthalmological signs. Learning points There are no clear guidelines on the management of pituitary apoplexy in pregnancy. A multidisciplinary approach can minimise morbidity and mortality. Pituitary apoplexy has an unpredictable clinical course and determining which clinical situations warrant early surgery needs to take into consideration the presence and severity of neurological signs and their stability. The management of conscious apoplectic patients with absent or mild and stable neuro-ophthalmological signs is controversial.

scholarly journals Visual disturbance as primary symptom of pituitary apoplexy in pregnancy

2021 ◽  
Vol 3 (4) ◽  
pp. 244-249
Author(s):  
Norazlida Ibrahim ◽  
Raja Norliza Binti Raja Omar ◽  
Mae-Lynn Catherine Bastion
Keyword(s):  
Visual Field ◽  
Pituitary Apoplexy ◽  
Wide Spectrum ◽  
Brain Mri ◽  
Visual Field Loss ◽  
Optic Chiasm ◽  
Visual Disturbance ◽  
Mortality And Morbidity ◽  
Pituitary Lesion ◽  
In Pregnancy

Pituitary apoplexy in pregnancy is a potentially fatal condition caused by acute ischaemic infarction or haemorrhage of pre-existing pituitary adenoma or within a physiologically enlarged pituitary gland. It has a wide spectrum of clinical presentations ranging from a mild headache to sudden collapsed. Here, we report a life-threatening case of pituitary apoplexy in a non-functioning pituitary macroadenoma occurring during pregnancy that presented with bilateral blurring of vision. Visual field showed bitemporal superior quadrantanopia. Urgent non-contrast brain MRI revealed an acute expansion of a hemorrhagic pituitary lesion complicated with local compression to the optic chiasm. The patient underwent an uneventful right supraorbital craniotomy and excision of the tumour under general anaesthesia with no foetal loss. The repeated visual field at 2 weeks after surgery showed recovering visual field defect. Hence, early neurosurgical intervention is advisable to prevent mortality and morbidity due to permanent visual field loss.

scholarly journals Stubborn hiccups as a sign of massive apoplexy in a naive acromegaly patient with pituitary macroadenoma

2017 ◽  
Vol 2017 ◽  
Author(s):  
Gulay Simsek Bagir ◽  
Soner Civi ◽  
Ozgur Kardes ◽  
Fazilet Kayaselcuk ◽  
Melek Eda Ertorer
Keyword(s):  
Pituitary Apoplexy ◽  
Pituitary Surgery ◽  
Optic Chiasm ◽  
Oral Glucose ◽  
List Type ◽  
Pituitary Macroadenoma ◽  
Large Tumor ◽  
Gh Secretion ◽  
Transsphenoidal Pituitary Surgery ◽  
Magnetic Resonance Imaging Mri

Summary Pituitary apoplexy (PA) may very rarely present with hiccups. A 32-year-old man with classical acromegaloid features was admitted with headache, nausea, vomiting and stubborn hiccups. Pituitary magnetic resonance imaging (MRI) demonstrated apoplexy of a macroadenoma with suprasellar extension abutting the optic chiasm. Plasma growth hormone (GH) levels exhibited suppression (below <1 ng/mL) at all time points during GH suppression test with 75 g oral glucose. After treatment with corticosteroid agents, he underwent transsphenoidal pituitary surgery and hiccups disappeared postoperatively. The GH secretion potential of the tumor was clearly demonstrated immunohistochemically. We conclude that stubborn hiccups in a patient with a pituitary macroadenoma may be a sign of massive apoplexy that may result in hormonal remission. Learning points: Patients with pituitary apoplexy may rarely present with hiccups. Stubborn hiccupping may be a sign of generalized infarction of a large tumor irritating the midbrain. Infarction can be so massive that it may cause cessation of hormonal overproduction and result in remission.

scholarly journals The use of cinacalcet in pregnancy to treat a complex case of parathyroid carcinoma

2014 ◽  
Vol 2014 ◽  
Author(s):  
K Nadarasa ◽  
M Bailey ◽  
H Chahal ◽  
O Raja ◽  
R Bhat ◽  
...  
Keyword(s):  
Parathyroid Carcinoma ◽  
Thyroid Tissue ◽  
Complex Case ◽  
High Dose ◽  
List Type ◽  
Radiological Findings ◽  
Chronic Knee Pain ◽  
Healthy Infants ◽  
Learning Points ◽  
In Pregnancy

Summary We present the case of a patient with metastatic parathyroid carcinoma whose hypercalcaemia was medically managed through two pregnancies. The diagnosis was made when the patient presented with chronic knee pain and radiological findings consistent with a brown tumour, at the age of 30. Her corrected calcium and parathyroid hormone (PTH) levels were significantly elevated. Following localisation studies, a right parathyroidectomy was performed with histology revealing parathyroid carcinoma, adherent to thyroid tissue. Aged 33, following biochemical recurrence of disease, the patient underwent a second operation. A subsequent CT and FDG–PET revealed bibasal pulmonary metastases. Aged 35, the patient was referred to our unit for treatment of persistent hypercalcaemia. The focus of treatment at this time was debulking metastatic disease using radiofrequency ablation. Despite advice to the contrary, the patient conceived twice while taking cinacalcet. Even though there are limited available data regarding the use of cinacalcet in pregnancy, both pregnancies continued to term with the delivery of healthy infants, using intensive medical management for persistent hypercalcaemia. Learning points Parathyroid carcinoma is a rare cause of primary hyperparathyroidism. Hypercalcaemia during pregnancy can result in significant complications for both the mother and the foetus. The use of high-dose cinacalcet in pregnancy has been shown, in this case, to aid in the management of resistant hypercalcaemia without teratogenicity.

scholarly journals Recurrent pituitary apoplexy in pregnancy

2021 ◽  
Vol 14 (8) ◽  
pp. e242353
Author(s):  
Franziska Geissler ◽  
Irene Hoesli ◽  
Monya Todesco Bernasconi
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Preterm Delivery ◽  
Pituitary Apoplexy ◽  
Signs And Symptoms ◽  
Visual Disturbance ◽  
Severe Headache ◽  
Altered Consciousness ◽  
Existing Data ◽  
In Pregnancy

Pituitary apoplexy is caused by haemorrhage or infarction of the pituitary gland. Presenting signs and symptoms often include severe headache, visual disturbance, ophthalmoplegia, altered consciousness and impaired pituitary function. The management of pituitary apoplexy has very rarely been described during pregnancy and there is no existing data for further pregnancies of affected women. We present a case of a woman with a recurrent pituitary apoplexy due to haemorrhages in a pituitary adenoma in her third and fourth pregnancies. In both pregnancies, the pituitary apoplexy was managed conservatively, but due to therapy-resistant headaches, a preterm delivery was implemented.

Acute Headache in Pregnancy

2017 ◽  
Author(s):  
M. Angela O’Neal
Keyword(s):  
Growth Hormone ◽  
Adrenocorticotropic Hormone ◽  
Pituitary Apoplexy ◽  
Optic Chiasm ◽  
Visual Disturbance ◽  
Electrolyte Imbalance ◽  
Clinical Feature ◽  
Acute Headache ◽  
Optic Nerve Involvement ◽  
In Pregnancy

The case illustrates the characteristics of pituitary apoplexy. This anatomy of the pituitary, which predisposes to the condition, is described. The most common clinical feature is headache. Visual disturbance related to optic chiasm or optic nerve involvement is also common. Pituitary apoplexy is a neuroendocrine emergency. The most important hormone involved is adrenocorticotropic hormone, ACTH. However, there are often multiple hormonal deficiencies: growth hormone, hypothyroidism, and hypogonadotropic deficiency. A high prolactin level may reflect a prolactinoma or be due to hypothalamic inhibition. Diabetes insipidus (DI) is also common. The most urgent issue in treating pituitary apoplexy is prompt assessment of fluid and electrolyte imbalance and the replacement of corticosteroids.

scholarly journals Recurrent pituitary apoplexy due to two successive neoplasms presenting with ocular paresis and epistaxis

2015 ◽  
Vol 2015 ◽  
Author(s):  
Stephanie Teasdale ◽  
Fahid Hashem ◽  
Sarah Olson ◽  
Benjamin Ong ◽  
Warrick J Inder
Keyword(s):  
Pituitary Apoplexy ◽  
Abducens Nerve ◽  
Pituitary Neoplasms ◽  
List Type ◽  
Rare Presentation ◽  
Intrasellar Pressure ◽  
Pituitary Lesion ◽  
Tumour Infiltration ◽  
Bilateral Abducens ◽  
Learning Points

Summary A case of recurrent pituitary apoplexy is described in a 72-year-old man who initially presented with haemorrhage in a non-functioning pituitary adenoma. Five years later, he re-presented with a severe pituitary haemorrhage in an enlarging sellar mass invading both cavernous sinuses causing epistaxis and bilateral ocular paresis. Subsequent histology was consistent with a sellar malignant spindle and round cell neoplasm. Multiple pituitary tumours have previously been reported to coexist in the same individual, but to our knowledge this is the only case where two pathologically distinct pituitary neoplasms have sequentially arisen in a single patient. This case is also notable with respect to the progressive ocular paresis, including bilateral abducens nerve palsies, and the presentation with epistaxis. Learning points Ocular paresis in pituitary apoplexy can result from tumour infiltration of nerves, or by indirect compression via increased intrasellar pressure. Epistaxis is a very rare presentation of a pituitary lesion. Epistaxis more commonly occurs following trans-sphenoidal surgery, and can be delayed.

THIOURACIL TREATMENT IN PREGNANCY AND LACTATION IN THE DOG

1962 ◽  
Vol 40 (3) ◽  
pp. 430-440 ◽  
Author(s):  
K. E. Arosenius ◽  
H. Derblom ◽  
G. Nylander
Keyword(s):  
Thyroid Gland ◽  
List Type ◽  
Histological Changes ◽  
Morphological Effect ◽  
Iodine Metabolism ◽  
Pregnancy And Lactation ◽  
In Pregnancy

ABSTRACT The offspring of bitches treated with thiouracil during pregnancy and lactation were studied with regard to certain aspects of iodine metabolism and also to the morphological effect on the thyroid gland, as compared with controls of the same age and weight. At the age of six months, when the dogs were virtually fully grown, the thyroid gland still exhibited the effects of the thiouracil treatment of the mothers as manifested by an increased uptake of 131I, enlargement, and histological changes of a hyperplastic type. The significance of these deviations from normal iodine metabolism and morphology is discussed with particular reference to the dangers of thiouracil medication during pregnancy.

Prolactinoma causing visual disturbance in pregnancy - a multidisciplinary management conundrum

2019 ◽  
Author(s):  
Sultana Azam ◽  
Rebecca Scott ◽  
Chioma Izzi-Engbeaya ◽  
Sheba Jarvis ◽  
Suhaniya Samarasinghe ◽  
...  
Keyword(s):  
Visual Disturbance ◽  
Multidisciplinary Management ◽  
In Pregnancy

scholarly journals Treatment and therapeutic strategies for pituitary apoplexy in pregnancy: a case series

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Yuya Kato ◽  
Yoshikazu Ogawa ◽  
Teiji Tominaga
Keyword(s):  
Pituitary Apoplexy ◽  
Clinical Symptoms ◽  
Case Series ◽  
Optimal Timing ◽  
Presenting Symptoms ◽  
Pathological Evaluation ◽  
Mother And Child ◽  
Life Threatening ◽  
In Pregnancy

Abstract Background Pregnancy is a known risk factor for pituitary apoplexy, which is life threatening for both mother and child. However, very few clinical interventions have been proposed for managing pituitary apoplexy in pregnancy. Case presentation We describe the management of three cases of pituitary apoplexy during pregnancy and review available literature. Presenting symptoms in our case series were headache and/or visual disturbances, and the etiology in all cases was hemorrhage. Conservative therapy was followed until 34 weeks of gestation, after which babies were delivered by cesarean section with prophylactic bolus hydrocortisone supplementation. Tumor removal was only electively performed after delivery using the transsphenoidal approach. All three patients and their babies had a good clinical course, and postoperative pathological evaluation revealed that all tumors were functional and that they secreted prolactin. Conclusions Although the mechanism of pituitary apoplexy occurrence remains unknown, the most important treatment strategy for pituitary apoplexy in pregnancy remains adequate hydrocortisone supplementation and frequent hormonal investigation. Radiological follow-up should be performed only if clinical symptoms deteriorate, and optimal timing for surgical resection should be discussed by a multidisciplinary team that includes obstetricians and neonatologists.

scholarly journals Canadian Association of Radiologists Recommendations for the Safe Use of MRI During Pregnancy

2021 ◽  
pp. 084653712110156
Author(s):  
Pejman Jabehdar Maralani ◽  
Anish Kapadia ◽  
Grace Liu ◽  
Felipe Moretti ◽  
Hournaz Ghandehari ◽  
...  
Keyword(s):  
Working Group ◽  
Energy Deposition ◽  
Expert Panel ◽  
Acoustic Noise ◽  
Evidence Based ◽  
Resonance Imaging ◽  
Canadian Association ◽  
Fetal Safety ◽  
Magnetic Resonance Imaging Mri ◽  
In Pregnancy

The use of magnetic resonance imaging (MRI) during pregnancy is associated with concerns among patients and health professionals with regards to fetal safety. In this work, the Canadian Association of Radiologists (CAR) Working Group on MRI in Pregnancy presents recommendations for the use of MRI in pregnancy, derived from literature review as well as expert panel opinions and discussions. The working group, which consists of academic subspecialty radiologists and obstetrician-gynaecologists, aimed to provide updated, evidence-based recommendations addressing safety domains related to energy deposition, acoustic noise, and gadolinium-based contrast agent use based on magnetic field strength (1.5T and 3T) and trimester scanned, in addition to the effects of sedative use and occupational exposure.

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