BACKGROUND:

Pituitary apoplexy is a sudden infarction or hemorrhage in a tumor or healthy tissue of the pituitary gland. Eighty percent of cases are in patients with a pituitary adenoma. The clinical picture is characterized by headache, visual disturbances, nausea and vomiting, and pituitary insufficiency, which can be life-threatening for the mother and fetus. Conservative treatment includes analgesics, corticosteroids and dopaminergic agonists in case of prolactinoma. The surgical treatment of choice is transsphenoidal resection.

CLINICAL CASE:

35-year-old female patient with a history of three pregnancies, one miscarriage and prolactinoma diagnosed at 22 years of age, under treatment with cabergoline. She came for consultation due to headache at 17 weeks of pregnancy that was exacerbated at 28.4 weeks. Magnetic resonance imaging showed that the pituitary gland measured 17 x 12 x 7 mm, with evidence of subacute hemorrhage; based on this, a diagnosis of pituitary apoplexy was made. Conservative treatment with non-steroidal anti-inflammatory drugs, opioids and corticosteroids was indicated; however, due to the deterioration of the clinical picture, endoscopic transseptal-transsphenoidal resection of the pituitary adenoma was decided at 30.5 weeks of pregnancy. The patient showed significant improvement and remained asymptomatic until the end of pregnancy at 37.5 weeks.

CONCLUSIONS:

Although pituitary apoplexy is of low incidence in pregnancy, it becomes a risk factor for death; therefore, the obstetrician/gynecologist should be aware of the possible implications in pregnancy, offer multidisciplinary care and consider that surgical treatment is a safe option in pregnancy.