Pituitary apoplexy as a consequence of lymphocytic adenohypophysitis in a pregnant woman: a case report.
OBJECTIVE
A patient with pituitary apoplexy resulting from lymphocytic adenohypophysitis, which caused visual disturbance during pregnancy, is described. This is the first report of such case.


METHODS
A 23-year-old primigravida in her 25th week of gestation experienced headache and bitemporal hemianopsia of sudden onset. Magnetic resonance imaging (MRI) revealed a large pituitary mass with intratumoral hemorrhage. Although conservative treatment with intravenous glycerol improved the symptoms partially, the visual symptoms worsened again 6 weeks later. After delivering a girl by scheduled caesarean section her visual symptoms improved. Despite the symptomatic improvement, MRI showed the chiasmatic compression by the enlarged pituitary gland had not changed. Therefore, trans-sphenoidal surgery to decompress the chiasm was performed. Necrotic tissue was seen exuding behind the enlarged pituitary gland and adenohypophysitis with bleeding (apoplexy) was diagnosed histologically. After follow-up for 40 months, she was doing well without any visual or neurological deficits.


CONCLUSIONS
Although relatively rare, pituitary apoplexy as a consequence of lymphocytic adenohypophysitis should be borne in mind when a pregnant woman presents with headache and visual disturbance of sudden onset.
Fujimaki
Takamitsu
T
Departments of Neurosurgery, Teikyo University School of Medicine, Kaga, Japan. tfujimak-tky@umin.ac.jp
Hotta
Shinji
S
Mochizuki
Toshihiro
T
Ayabe
Takuya
T
Matsuno
Akira
A
Takagi
Kiyoshi
K
Nakagomi
Tadayoshi
T
Tamura
Akira
A
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D010899:Pituitary Apoplexy / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D010900:Pituitary Diseases / Q000150:complications* / Q000473:pathology / Q000601:surgery; D011247:Pregnancy; D037841:Pregnant People; D013194:Staining and Labeling / Q000379:methods