Tuberculum sellae meningioma symptomatic during pregnancy: pathophysiological considerations.
A 31 year old woman in her second pregnancy presented in the 31st (+4) week of gestation with progressive visual impairment of the right eye. Magnetic resonance imaging (MRI) demonstrated a tuberculum sellae meningioma that was displaced upward by a markedly enlarged pituitary gland. Neuro-ophthalmological follow-up examinations showed a progressive decrease of visual acuity and right temporal field loss. Therefore, a caesarean section was performed in the 34th (+8) week. The meningioma was removed three days after childbirth via a right-sided pterional approach. Post-operatively, visual function was completely restored. Immunohistochemical examination showed positive staining for progesterone receptors (PR) in approximately 50% of tumour cells. Enlargement of the pituitary gland during late pregnancy in conjunction with a preexisting tuberculum sellae meningioma is the most likely pathophysiological factor responsible for visual loss. Enlargement of the PR-positive meningioma in the hormonal milieu of pregnancy might have contributed additionally to visual loss.
Ebner
F H
FH
Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany. florianebner@virgilio.it
Bornemann
A
A
Wilhelm
H
H
Ernemann
U
U
Honegger
J
J
D000328:Adult; D005260:Female; D006801:Humans; D008577:Meningeal Neoplasms / Q000473:pathology* / Q000503:physiopathology; D008579:Meningioma / Q000473:pathology* / Q000503:physiopathology; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000473:pathology* / Q000503:physiopathology; D012658:Sella Turcica; D014786:Vision Disorders / Q000209:etiology*