Gestational Pituitary Apoplexy With Persistent Hypogonadotropic Hypogonadism

Abstract

Background/objective: Pituitary apoplexy (PA) is a rare and life-threatening emergency that remains prone to misdiagnosis, especially in pregnancy. Few cases of gestational PA have been reported in the literature.

Case report: This study reports a case of a 26-year-old woman presenting at 35 weeks of gestation with PA.

Discussion: Initial presentation included severe headache, blurry vision, and dizziness, and conservative medical management was opted. This included stress-dose hydrocortisone, cabergoline, and levothyroxine, followed by cesarean delivery at 36 weeks of gestation. The patient retrieved normal pituitary function, except for persistent amenorrhea 2 years after.

Conclusion: This is the first case of isolated persistent hypogonadotropic hypogonadism following PA in a pregnant patient and opens the discussion on the variety of potential complications of this condition.

Keywords: endocrinology; obstetrics; pituitary apoplexy; pregnancy.

Fig. 1

Magnetic resonance imaging. T2 coronal (A) and sagittal (B) views showing a pituitary expansion with liquid and hemorrhagic components and discrete expansion into the left cavernous fossa with compression of the optic chiasm’s left side, sparing the left internal carotid artery. Dimensions, 20 × 18 × 16 mm.

Fig. 2

Magnetic resonance imaging. T2 (a) and T2-fluid-attenuated inversion recovery (b) coronal (A) and sagittal (B) views showing normal size pituitary gland with nonvascularized pseudomicrocystic regions suggesting the sequelae of the pituitary apoplexy. Pituitary stalk markedly deviated to the left.