Images in Clinical Medicine
Gestational Pituitary-Tumor Apoplexy
N Engl J Med 2010; 363:e10August 12, 2010
- Article
A 31-year-old woman with a history of prolactinoma was admitted at the 39th week of her first pregnancy for headache and nausea. She had been receiving bromocriptine until she became pregnant. The neurologic examination, which included a dilated fundus examination and visual-field screening, was normal. Magnetic resonance imaging (MRI), consisting of a T2-weighted image in the axial plane (Panel A) and a T1-weighted image in the midsagittal plane (Panel B), revealed an intrasellar mass with suprasellar extension (arrows) and fluid levels consistent with recent bleeding into the macroadenoma. These findings are typical of pituitary-tumor apoplexy. Pituitary-tumor apoplexy is an acute hemorrhagic infarction of a preexisting pituitary adenoma. It often results from the short-term expansion of an adenoma, which occurs frequently during pregnancy. It can result in sudden, severe headache, visual disturbances, and impairment of pituitary function. Computed tomography and MRI confirm the diagnosis. Treatment consists of bromocriptine, with hormone-replacement therapy if needed. Our patient underwent immediate cesarean section and initiation of bromocriptine treatment, with subsequent resolution of the headache and nausea. At a follow-up visit nearly 2 years later, there was no deficit in pituitary function. Repeated MRI revealed that the intrasellar findings had resolved.
Shimon Ginath, M.D.
Abraham Golan, M.D.
Wolfson Medical Center, Holon, Israel
ginath@gmail.com - Citing Articles (2)
Citing Articles
1
Kathleen B. Digre. (2011) Neuro-Ophthalmology and Pregnancy. Journal of Neuro-Ophthalmology 31:4, 381-387
CrossRef2
Claudia Tonda, Ali A. Rizvi. (2011) Headache, Pituitary Lesion and Panhypopituitarism in a Pregnant Woman: Tumor, Apoplexy or Hypophysitis?. The American Journal of the Medical Sciences 342:3, 247-249
CrossRef
