Overcoming anaesthetic challenges in a pregnant woman with pituitary apoplexy undergoing endoscopic trans-sphenoidal resection of the pituitary tumour

BMJ Case Rep. 2023 May 29;16(5):e254299. doi: 10.1136/bcr-2022-254299.

Abstract

Pituitary apoplexy is a rare condition that occurs due to acute haemorrhage in the pituitary gland and usually presents with features of acute hypopituitarism, visual defects and ophthalmoplegia. Pregnancy is one of the risk factors for pituitary apoplexy. Medical management is the first line of management in pregnancy irrespective of the gestational age. However, acute neuro-ophthalmological deterioration might warrant an urgent surgical decompression. Preoperative corticosteroids have dual benefits of providing hormonal replacement in the mother and also promoting fetal lung maturity in the offspring. Uterine contractions should be monitored and tocolysis provided as per requirements in a post-viable fetus.

Keywords: Neuroanaesthesia; Neuroendocrinology; Pituitary disorders; Pregnancy.

Publication types

  • Case Reports

MeSH terms

  • Anesthetics*
  • Female
  • Humans
  • Pituitary Apoplexy* / surgery
  • Pituitary Gland / pathology
  • Pituitary Neoplasms* / complications
  • Pituitary Neoplasms* / pathology
  • Pituitary Neoplasms* / surgery
  • Pregnancy
  • Pregnant Women

Substances

  • Anesthetics