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Review
. 2019 May 5;12(5):e228323.
doi: 10.1136/bcr-2018-228323.

Visual loss in pregnancy

Caroline Annette Erika Bachmeier  1 , Cameron Snell  2 , Adam Morton  1
Affiliations
Review

Visual loss in pregnancy

Caroline Annette Erika Bachmeier et al. BMJ Case Rep. .

Abstract

Visual loss in pregnancy may be caused by a variety of reasons including pituitary adenomas. Prolactinomas (PRLs) are the most common hormone-secreting tumours in pregnant women. As most PRLs present with menstrual abnormalities, infertility or galactorrhoea, they are most commonly diagnosed before pregnancy. We present the case of a 30-year-old primigravida who presented at 36+5 weeks gestation with headaches and left-sided visual loss. MRI of the pituitary gland confirmed a 10×11 mm left suprasellar mass. Results of her anterior pituitary function were unremarkable for her gestational age. Postpartum, she underwent an endoscopic endonasal resection of the pituitary tumour. The histology was consistent with a PRL. Literature review reveals only one possible case of a new diagnosis of a PRL during pregnancy. It highlights the importance to consider a wide range of differential diagnoses when assessing visual loss in pregnancy.

Keywords: endocrinology; neuro-ophthalmology; obstetrics and gynaecology; pituitary disorders; pregnancy.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Single field analysis of the left eye: inferotemporal field defect.
Figure 2
Figure 2
Postpartum stealth protocol MRI with gadolinium enhancement, coronal (left) and sagittal (right) images: left suprasellar mass measuring 10×11×11 mm with localised mass effect with superior displacement and compression of the optic chiasm and left optic nerve.
Figure 3
Figure 3
(A) Microscopic appearance of pituitary lesion (H&E stain, magnification ×20). (B) Microscopic appearance of basophilic tumour arranged in sheets and discohesive papillae with cells containing large nuclei with multiple nucleoli (H&E stain, magnification ×200). (C) Ki67 staining showing proliferative fraction of <1% (magnification ×200). (D) Immunohistochemistry with strong paranuclear dot positivity for prolactin (magnification ×200).
See this image and copyright information in PMC

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