Download PDF
Minim Invasive Neurosurg 2003; 46(3): 173-176
DOI: 10.1055/s-2003-40734
Case Report
© Georg Thieme Verlag Stuttgart · New York

Minimally Invasive Pituitary Surgery in a Hemorrhagic Necrosis of Adenoma During Pregnancy

J.  Gondim1 , F.  Ramos Jr.1 , I.  Pinheiro2 , M.  Schops3 , O.  I.  Tella Jr.4
  • 1Department of Neurosurgery, General Hospital of Fortaleza, Brazil
  • 2Department of Oto-rhino-laryngology, General Hospital of Fortaleza, Brazil
  • 3Department of Anesthesiology, Federal University of Ceará (UFC), Brazil
  • 4Department of Neurosurgery, Federal University of São Paulo (UNIFESP), Brazil
Further Information

Publication History

Publication Date:
21 July 2003 (online)

    Permissions and Reprints

Abstract

A 29-year-old woman with a prolactin microadenoma was under good control with bromocriptine (BCP) therapy until she became pregnant, when the treatment was stopped. During the third trimester of pregnancy the patient presented a unilateral visual loss and intermittent headaches. BCP was restarted and one week later she developed a complete ophthalmoplegia on the other side. The patient was submitted to an endoscopic transnasal transeptal resection of a hematoma and tumoral tissue in the pituitary region. One month after surgery, at 39 weeks of gestation, the patient spontaneously delivered a healthy girl weighing 3 kg, with an Apgar score of 9 and 10 at five minutes. This is the first case in the literature of a pregnant woman with second and third cranial nerve lesions, submitted to minimally invasive neuroendoscopic transnasal transsphenoidal approach in the third trimester of pregnancy.

Key words

Pregnancy - pituitary apolexy - endoscope - minimally invasive

References

  • 1 Horvath E, Kovacs K. The adenohypophysis. In: Kovacs K, Asa SL (ed). Functional Endocrine Pathology. Boston: Blackwell Sciences 1991: 245-281
    Search in Google Scholar
  • 2 Molith M E. Management of prolactinomas during pregnancy.  J Reprod Med. 1999;  44 1121-1126
    PubMedSearch in Google Scholar
  • 3 Randeva H, Davis M, Prelevic G. Prolactinoma and pregnancy.  Br J Obs Gyn. 2000;  107 1064-1068
    PubMedSearch in Google Scholar
  • 4 Ester A D, Sanders T G, Vines F S. Size and shape of the pituitary gland during pregnancy and post partum: Measurement with MR imaging.  Radiology. 1991;  181 531-532
    PubMedSearch in Google Scholar
  • 5 Miki Y, Asato R, Okumura R. Anterior pituitary gland in pregnancy: Hyperintensity at MR.  Radiology. 1993;  187 223-229
    PubMedSearch in Google Scholar
  • 6 Dinç H, Esen F, Demirci A. Pituitary dimensions and volume measurements in pregnancy and post partum.  Acta Radiol. 1998;  39 64-69
    PubMedSearch in Google Scholar
  • 7 Vician L, Shupnik M, Gorski J. Effects of estrogen on primary ovine pituitary cell cultures: Stimulation of prolactin secretion, synthesis, and preprolactin messenger ribonucleic acid activity.  Endocrinology. 1979;  104 736-743
    PubMedSearch in Google Scholar
  • 8 Maurer R. Relationship between estradiol, ergocryptine, and thyroid hormone: Effects on prolactin synthesis and prolactin messenger ribonucleic acid levels.  Endocrinology. 1982;  110 1515-1520
    PubMedSearch in Google Scholar
  • 9 Rakoff J, Yen S. Progesterone induced acute release of prolactin in estrogen primed ovariectomized women.  J Clin Endocrinol Metab. 1978;  47 918-922
    PubMedSearch in Google Scholar
  • 10 Asa S, Penz C, Kovacs K, Ezrin C. Prolactin cells in the human pituitary: a quantitative immunocytochemical analysis.  Arch Pathol Lab Med. 1982;  106 360-363
    PubMedSearch in Google Scholar
  • 11 Pressman E, Zeidman S, Reddy U, Epstein J, Brem H. Differentiating lymphocytic adenohypophysitis from pituitary adenoma in the peripartum patient.  J Reprod Med. 1995;  40 251-259
    PubMedSearch in Google Scholar
  • 12 Thorner M O, Perryman R I, Rogol A D, Conway B P, Macleod R M, Login I S. Rapid changes of prolactinoma volume after withdrawal and reinstitution of bromocriptine.  J Clin Endocrinol Metab. 1981;  53 480-483
    PubMedSearch in Google Scholar
  • 13 Shanis B S, Check J H. Relative resistance of a microprolactinoma to bromocriptine therapy during pregnancy.  Gynecol Endocrinol. 1996;  10 91-94
    PubMedSearch in Google Scholar
  • 14 Gemzell C, Wang C F. Outcome of pregnancy in women pituitary adenomas.  Fertil Steril. 1979;  31 363-372
    PubMedSearch in Google Scholar
  • 15 Ahmed M, Al-Dossary E, Woodhouse N J. Macroprolactinomas with suprasellar extension: effect of bromocriptine withdrawal during one or more pregnancies.  Fertil Steril. 1992;  58 492-497
    PubMedSearch in Google Scholar
  • 16 Cunnah D, Besser M. Management of prolactinoma.  Clin Endocrinol (Oxf). 1990;  34 231-235
    PubMedSearch in Google Scholar
  • 17 Ruiz-Velasco V, Tolis G. Pregnancy in hyperprolactinemic women.  Fertil Steril. 1984;  41 793-805
    PubMedSearch in Google Scholar
  • 18 Molith M E. Pregnancy and the hyperprolactinemic woman.  N Engl J Med. 1985;  312 1364-1370
    PubMedSearch in Google Scholar
  • 19 Bergh T, Nillus S J, Enoksson P, Larson G, Wide L. Bromocriptin-induced pregnancies in women with large prolactinomas.  Clin Endocrinol (Oxf). 1982;  17 625-631
    PubMedSearch in Google Scholar
  • 20 Child D, Gordon H, Mashiter K, Joplin G. Pregnancy, prolactin and pituitary tumors.  Br Med J. 1975;  4 87-89
    PubMedSearch in Google Scholar
  • 21 Krupp P, Monka C, Richter K. The safety aspects of infertility treatments. Proc of the Second World Congress of Gynecology and Obstetrics, Rio de Janeiro,. October 1988
    Search in Google Scholar
  • 22 Konopka P, Raymond J, Meceron R. Continuous administration of bromocriptine in the prevention of neurological complications in pregnant women with prolactinomas.  Am J Obstet Gynecol. 1983;  146 935-938
    PubMedSearch in Google Scholar
  • 23 Musolino N, Bronstein M. Prolactinomas and pregnancy: Use of dopamine agonists: Bromocriptime and cabergoline. Proc of the 6th International Pituitary Congress, Long Beach, California. 1999
    Search in Google Scholar
  • 24 van Roon E, van der Vijver J C, Gerretsen G, Hekster R E, Waddendorff R A. Rapid regression of a suprasellar estending prolactinoma after bromocriptine treatment during pregnancy.  Fertil Steril. 1981;  36 173-177
    PubMedSearch in Google Scholar
  • 25 Crosignani P G, Mattei A M, Severini V, Cavioni V, Maggioni P, Testa G. Long-term effects of time, medical treatment and pregnancy in 176 hyperprolactinemic women.  Eur J Obs Rep Biology. 1992;  40 175-180
    PubMedSearch in Google Scholar
  • 26 Modena G, Portioli I. Delivery after bromocriptine therapy.  Lancet. 1977;  2 558
    PubMedSearch in Google Scholar
  • 27 Yuen B. Bromocriptine, pituitary tumours, and pregnancy.  Lancet. 1978;  2 1314
    PubMedSearch in Google Scholar
  • 28 Griffith R W, Turkalj I, Braun P. Outcome of pregnancy in mothers given bromocriptine.  Br J Clin Pharmacol. 1978;  5 227-231
    PubMedSearch in Google Scholar
  • 29 Parks D. Drug therapy: bromocriptine.  New Engl J Med. 1979;  301 873-878
    PubMedSearch in Google Scholar
  • 30 Turkalj I, Braun P, Krupp P. Surveillance of bromocriptine in pregnancy.  JAMA. 1982;  247 1589-1591
    CrossrefPubMedSearch in Google Scholar
  • 31 Raymond J P, Goldsteine E, Kanopka P, Lelu M F, Merceron R E, Loria Y. Follow up of children born of bromocriptine-treated mothers.  Horm Res. 1985;  22 239-246
    PubMedSearch in Google Scholar
  • 32 Freeman R, Wezenter B, Silverstein M, Kuo D, Weiss K, Kantrowitz A. Pregnancy-associated subacute hemorrhage into a prolactinoma resulting in diabetes insipidus.  Fertil Steril. 1992;  58 427-429
    PubMedSearch in Google Scholar
  • 33 Labauge R, Pages A, Pages M, Ribstein J, Richard L. Necrose hemorragique d'un adenome hypophysaire polyoncose endocrinienne.  Rev Neurol (Paris). 1982;  138 149-158
    PubMedSearch in Google Scholar
  • 34 Saunders N. Prolactinoma during pregnancy causing compression symptoms responding to bromocriptine therapy.  Postgrad Med J. 1985;  61 829-830
    PubMedSearch in Google Scholar
  • 35 Wykes W. Prolactinoma presenting with intermittent third nerve palsy.  Br J Ophthalmol. 1986;  70 706-707
    PubMedSearch in Google Scholar
  • 36 Fong L, Fabinyi G. Ophthalmic manifestations of pituitary apoplexy.  Med J Aust. 1985;  142 142-143
    PubMedSearch in Google Scholar
  • 37 Crosignani P G, Ferrari C, Mattei A M. Visual field defects and reduced visual acuity during pregnancy in two patients with prolactinoma: rapid regression of symptoms under bromocriptine. Case report.  Br J Obstet Gynecol. 1984;  91 821-823
    PubMedSearch in Google Scholar
  • 38 Holgren U, Bergstrand G, Hagenfeldt K, Werner S. Women with prolactinoma - effect of pregnancy and lactation on serum prolactin and tumor growth.  Acta Endocrinol. 1986;  111 452-459
    PubMedSearch in Google Scholar
  • 39 Rasmussen C, Bergh T, Wide L. Prolactin secretion and menstrual function after long-term bromocriptine treatment.  Fertil Steril. 1987;  48 550-554
    PubMedSearch in Google Scholar
  • 40 Crosignani P, Mattei A, Scarduelli C, Cavioni V, Boracchi P. Is pregnancy the best treatment for hyperprolactinaemia?.  Human Reprod. 1989;  4 910-912
    PubMedSearch in Google Scholar
  • 41 Divers W, Yen S. Prolactin-producing microadenomas in pregnancy.  Obstet Gynecol. 1983;  61 425-429
    PubMedSearch in Google Scholar
  • 42 Kupersmith M J, Rosemberg C, Keimberg D. Visual loss in pregnant women with pituitary adenomas.  Ann Intern Med. 1994;  121 437
    PubMedSearch in Google Scholar
  • 43 Rjosk H, Fahlbusch R, Werder K. Influence of pregnancies on prolactinomas.  Acta Endocrinol. 1982;  100 337-346
    PubMedSearch in Google Scholar
  • 44 Canales E S, Garcia I C, Ruiz J E, Zarate A. Bromocriptine as prophylactic therapy in prolactinoma during pregnancy.  Fertil Steril. 1981;  36 524-526
    PubMedSearch in Google Scholar
  • 45 Bergh T, Nillius S, Larsson S, Wide L. Effects of bromocriptine induced pregnancy on prolactin secreting pituitary tumors.  Acta Endocrinol (Copenh). 1981;  98 333-338
    PubMedSearch in Google Scholar
  • 46 Goodman L A, Chang R J. Pregnancy after bromocriptine induced reduction of an extrasellar prolactin-secreting pituitary macroadenomas.  Obstet Gynecol. 1984;  64 (3 Suppl) 2s-7s
    PubMedSearch in Google Scholar
  • 47 Coremblum B. Successful outcome of ergocryptine-induced pregnancies in twenty-one women with prolactina-secreting pituitary adenomas.  Fertil Steril. 1979;  32 183-186
    PubMedSearch in Google Scholar
  • 48 Glick R P, Tiesi J Á. Subacute pituitary apoplexy: clinical and magnetic resonance imaging characteristics.  Neurosurgery. 1990;  27 214-219
    CrossrefPubMedSearch in Google Scholar
  • 49 Onesti S T, Wisniewski T, Post K D. Clinical versus subclinical pituitary apoplexy: presentation, surgical management, and outcome in 21 patients.  Neurosurg. 1990;  26 990-996
    PubMedSearch in Google Scholar
  • 50 Gondim J, Pinheiro I. Neuroendoscopic endonasal transseptal approach to the sellar region: study of 30 cases.  Arq Neuropsiquiatr. 2001;  59 901-904
    PubMedSearch in Google Scholar

Dr. J. Gondim

Instituto de Neurologia

1805 Pereira Filgueiras Street

Fortaleza

Brazil 60.181-560

Phone: +55-85-265-5768

Fax: +55-85-265-5768

Email: jagondim@secrel.com.b