Pituitary apoplexy as a consequence of lymphocytic adenohypophysitis in a pregnant woman: a case report

OBJECTIVE AND IMPORTANCE: 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. CLINICAL PRESENTATION: 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. CONCLUSION: 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.     

Pituitary abscess in a patient with painless thyroiditis.

The preoperative diagnosis of pituitary abscess is difficult. The case of a 56-year-old man with a pituitary abscess and painless thyroiditis is presented. There has been no previous such report. The differential diagnosis includes pituitary abscess, lymphocytic adenohypophysitis or infundibuloneurohypophysitis, share clinical symptoms of panhypopituitarism and diabetes insipidus, and is of critical importance as the treatment of these conditions differ. The association with painless thyroiditis suggests a diagnosis of lymphocytic adenohypophysitis or infundibuloneurohypophysitis. However, the coincidence of pituitary abscess and painless thyroiditis was observed in our patient, and thus though rare, should be considered. Surgical exploration and histopathological examination are essential for the differential diagnosis of these diseases.     

Pituitary abscess

Pituitary abscess is a rare disease, but one with potentially high mortality and morbidity. We present a 46-year-old man with progressive visual disturbance and general malaise for 1 year. Endocrine studies revealed hypopituitarism, and magnetic resonance imaging revealed a pituitary lesion with suprasellar extension. We attempted to excise the lesion using a transsphenoidal approach, but pus in the pituitary fossa was found at operation, and no tumour was identified. The culture yielded coagulase-negative Staphylococcus. Antibiotics were administered for 3 weeks, and the patient made a good postoperative recovery. He required life-long hormone replacement therapy. After one and a half years of follow-up, he was well and had no evidence of focal or systemic infection. We review the literature regarding pituitary abscess and discuss the appropriate treatment and possible pathological mechanism.     

Pituitary abscess

A 28-year-old Caucasian woman presented with a 12 month history of secondary amenorrhoea, polyuria and polydipsia with fatigue and weight loss. Investigations revealed panhypopituitarism, diabetes insipidus, an intrasellar mass and papilloedema, thought to be due to benign intracranial hypertension. She was treated conservatively. However, a repeat magnetic resonance image showed enlargement of the pituitary mass with compression of the optic nerves. The pituitary abscess was drained by a transsphenoidal approach. Postoperatively the patient received antibiotics with no recurrence of the pituitary abscess.     

Aripiprazole use in a pregnant schizoaffective woman

BACKGROUND: There are few or no clinical data on the safety of aripiprazole during pregnancy and lactation. CASE REPORT: A 27-year-old schizoaffective woman conceived while receiving aripiprazole 15 mg/day. The drug was withdrawn during the eighth week of gestation. She relapsed at week 20, and resumed treatment with the drug at a dose of 10 mg/day. She responded well, and the drug was continued through the rest of the pregnancy. The pregnancy was uneventful, but unexplained fetal tachycardia necessitated a cesarean section at full term. The newborn infant was normal in all regards and developed normally during a 6-month follow up. The infant required to be bottle-fed because of a failure of lactation. CONCLUSION: In this case, exposure to aripiprazole during different trimesters of pregnancy was not associated with intrauterine death, morphological teratogenicity, impaired fetal growth, neonatal toxicity, or neurobehavioral teratogenicity. Maternal health was not adversely affected during pregnancy. However, lactation failure occurred after delivery.     

Low back pain in a pregnant woman

Low back pain is very common and often considered a part of normal pregnancy. Because the pain is always attributed to pregnancy, referral to a specialist is often delayed. We describe a young woman who developed low back pain and signs of progressive spinal cord compression at 33 weeks' gestation of her second pregnancy. Magnetic resonance imaging of the thoracic spine showed a collapsed T11 vertebral body and a large paraspinal and intraspinal tumor compressing on the spinal cord from the right. Emergent surgical decompression and removal of the tumor mass was done. Pathological examination revealed metastatic adenocarcinoma and subsequently, a palpable nodule was found in the left breast, which, on biopsy, proved to be an invasive lobular carcinoma.     

Healthy outcome under olanzapine treatment in a pregnant woman

Our report focuses on the case of a pregnant women with recurrent, paranoid schizophrenia. The patient was treated with Olanzapine from the 18th gestational week until delivery and during breast-feeding. No adverse events occurred during pregnancy, and the outcome was healthy. After delivery, the plasma level of olanzapine in the infant was one-third of the maternal plasma level, and during breast-feeding, it decreased to an undetectable limit.     

垂体脓肿8例临床分析

目的探讨垂体脓肿的临床特征和治疗.方法回顾性分析8例垂体脓肿患者的临床表现、影像学特征、诊断和治疗,并结合文献进行分析.结果8例患者中仅1例有明显颅内感染征象,视力视野障碍者5例,尿崩者4例,垂体功能低下者4例,影像学常无特征性改变.4例经开颅手术,4例经蝶手术治疗.术后随访5例患者中4例脓肿无复发,视力视野改善者2例,尿崩者2例恢复正常,垂体功能低下者随访2例患者中1例恢复正常,1例经翼点入路手术者脓肿复发.结论垂体脓肿术前诊断困难,对鞍区囊性病变应考虑到垂体脓肿的可能,及早手术、正确地选择手术入路、合理应用抗生素和适当的对症治疗是治疗垂体脓肿的关键.     

Spinal angiolipoma in a pregnant woman presenting with acute epidural hemorrhage

A 26-year-old woman in week 31 of pregnancy presented to the emergency room with acute onset of paraplegia. Her medical history was unremarkable. Neurological examination revealed complete paraplegia, total sensory loss below the T7 dermatome, and significant vesicorectal dysfunction. MRI revealed an intraspinal mass from T3 to T4, which was hyperintense on both T1-weighted and T2-weighted images. Blood examination found no abnormality. She underwent emergent hemilaminectomy and removal of the hematoma. Intraoperatively, unusually ectatic venous vessels were found adhered to the lower surface of the epidural clot. No concurrent vascular malformations were identified and the dura mater was intact. The histological diagnosis was angiolipoma. Postoperatively her neurological deficits showed remarkable improvement, and she gave birth to a healthy baby. Spinal angiolipoma in a pregnant woman may be complicated with acute epidural hemorrhage. Emergent surgical evacuation can be performed safely with a good functional prognosis.     

Impending status epilepticus and anxiety in a pregnant woman treated with levetiracetam

Levetiracetam (LEV) has been considered to undergo no significant change in bioavailability during pregnancy; however, it was recently demonstrated to display modifications leading to a drop in its serum level. We describe a patient who displayed impending status epilepticus following a fall in her LEV level during the first trimester. The oral LEV dosage was increased, and phenytoin and benzodiazepines were transiently prescribed. She experienced severe anxiety and an unbearable fear over the deleterious consequences for her baby despite repeated, reassuring explanations. Her anxiety was so strong that she aborted electively shortly after leaving the hospital. This observation emphasizes the need for LEV level monitoring during pregnancy to prevent unexpected seizure relapses. The rapid increase in levetiracetam dosage in parallel with the loss of seizure control is suspected of facilitating the induction of significant psychiatric changes.