Poster Abstract Abstract

(Adults - Pituitary/Neuroendocrinology), #220515839241

Non-functioning Pituitary Adenoma complicating Pregnancy

Deviga Lachumanan, Hospital Kuala Lumpur; Subashini Rajoo, Hospital Kuala Lumpur

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0165533097

Introduction

Pregnancies are rare in women with pituitary adenoma. We describe a patient with non-functioning pituitary adenoma who had a spontaneous pregnancy who developed progressive worsening of vision and underwent successful transsphenoidal surgery (TSS) at second trimester.

Methods

A 35-year-old woman presented with secondary amenorrhoea and galactorrhoea for 6 months. A large pituitary macroadenoma with mass effect coupled with mild increment of prolactin raised a suspicion of prolactinoma. Menstruation returned and galactorrhoea ceased following Cabergoline therapy. She had a left nasal hemianopia, central hypothyroidism and hypogonadotropic hypogonadism with intact other pituitary hormones. Although prolactin remained suppressed for a year with Cabergoline therapy, there was no reduction in tumour size and serial perimetry showed gradual worsening of visual fields in both eyes. She was planned for a TSS but it was postponed.

Results

She presented at 17 weeks of a spontaneous pregnancy with left eye discomfort and no other symptoms of raised intracranial pressure. MRI of the pituitary showed unchanged tumour size exhibiting mass effect with no evidence of apoplexy while perimetry showed worsening of peripheral scotoma on the left eye with optic atrophy and new onset of central hypocortisolism. She underwent TSS at 19 weeks POA and the HPE confirmed pituitary adenoma, stained negative for prolactin. Post-operatively she developed cranial diabetes insipidus requiring regular desmopressin with no improvement in vision.

Conclusion

Pregnancy is a known risk factor for pituitary apoplexy, but worsening of mass effect could be due to physiological changes of pregnancy resulting in pituitary enlargement. Surgery is recommended early prior to embarking on a pregnancy journey especially in those with large NFPA for optimal pregnancy outcomes. Patients who become pregnant despite all the odds, require multidisciplinary care and TSS at second trimester is an option. Hormonal deficiencies and cranial diabetes insipidus should be addressed promptly and managed timely.

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