Background: Pituitary apoplexy is an acute, life-threatening syndrome caused by hemorrhage or infarction of the pituitary gland, usually within a pre-existing adenoma. During pregnancy, the risk of apoplexy increases due to physiologic pituitary enlargement, lactotroph hyperplasia, and pregnancy-related hemodynamic and coagulation changes. This is the first case report of third-trimester pituitary apoplexy managed with simultaneous surgical decompression and delivery in the same OR.
Case description: A previously healthy 30 year-old female (G2T1P0A1L1) presented at 37w4d with bilateral blurry vision and was found to have bitemporal hemianopia. CT head revealed a sellar mass with optic chiasm compression. She was admitted to neurosurgery and underwent urgent Caesarean section followed by endoscopic transsphenoidal resection/decompression within the same OR. Post-operatively, she developed central adrenal insufficiency and central hypothyroidism requiring hormone replacement. She was unable to breastfeed due to inappropriately low-normal postpartum prolactin and did not respond to a domperidone trial. Although she experienced polyuria postpartum, there was no evidence of central diabetes insipidus, and polyuria was attributed to normal postpartum diuresis.
Discussion: To our knowledge, this is the first reported case of concurrent Caesarean section and transsphenoidal decompression for third-trimester pituitary apoplexy. Neuroophthalmological symptoms require urgent neurosurgical intervention regardless of gestational age. Clinicians should anticipate possible post-operative hypopituitarism and lactation failure. Given the increased recurrence risk of apoplexy in future pregnancies, preconception counseling with neurosurgery, endocrinology, and obstetrics is recommended.
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