An unusual presentation of a pituitary tumour in the early postpartum period.
The case of a parturient, who first presented with a partial oculomotor nerve palsy shortly after caesarean delivery while participating in a clinical trial, is presented. The anaesthesia for the caesarean delivery involved a combined spinal-epidural with intrathecal bupivacaine and postoperative epidural pethidine patient-controlled analgesia. The trial was examining the possible effects of magnesium infusions on acute and chronic pain. The partial oculomotor nerve palsy was an unusual presentation and the signs and symptoms were transient. Magnetic resonance imaging confirmed the presence of a presumed pituitary macroadenoma. Possible reasons for the timing of onset and the rapid resolution of symptoms, and the implications and management of pituitary pathology in the peripartum period, are considered. The uncomplicated course of a later caesarean delivery in the same patient, using the same anaesthesia technique, is also noted.
School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia.
M J
MJ
Paech
D000236:Adenoma / Q000175:diagnosis* / Q000628:therapy; D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000379:methods; D002585:Cesarean Section; D017604:Cesarean Section, Repeat; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008991:Monitoring, Physiologic / Q000379:methods; D015840:Oculomotor Nerve Diseases / Q000175:diagnosis* / Q000628:therapy; D010298:Parity; D010911:Pituitary Neoplasms / Q000175:diagnosis* / Q000628:therapy; D049590:Postpartum Period; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis* / Q000628:therapy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors