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Case Reports and Images in Obstetrics and Gynecology

 
     
Case Report
 
Pituitary mass in pregnancy - unlikely to be an adenoma?
Emma Jayne Thornton1, Samantha Bonner1, Kanna Gnanalingham2, Piyali Pal3, Julian Davis4, Louise Byrd1
1Department of Obstetrics, Central Manchester University Hospitals Foundation NHS Trust., UK;
2Department of Neurosurgery, Central Manchester University Hospitals Foundaton NHS Trust, UK;
3Department of Pathology, Central Manchester University Hospitals Foundation NHS Trust, UK;
4Department of Endocrinology, Central Manchester University Hospitals Foundation NHS Trust., UK.

Article ID: 100034Z08ET2018
doi: 10.5348/100034Z08ET2018CR

Corresponding Author:
Emma Jayne Thornton,
Department of Obstetrics, Central Manchester University Hospitals Foundation NHS Trust,
UK

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How to cite this article
Thornton EJ, Bonner S, Gnanalingham K, Pal P, Davis J, Byrd L. Pituitary mass in pregnancy – unlikely to be an adenoma? J Case Rep Images Obstet Gynecol 2018;4: 100034Z08ET2018.


ABSTRACT
Introduction: Lymphocytic hypophysitis (LH) is a rare disease with an annual incidence of approximately one in ten million population. A subsequent pregnancy after pituitary surgery is even rarer.
Case Report:A 21-year-old primigravida who developed a sudden onset of headache and blurred vision at 35 weeks gestation. Formal examination at the local eye hospital revealed a bitemporal hemianopia and subsequent MRI indicated a pituitary mass with suprasellar extension and chiasmal compression. Transphenoidal endoscopic resection was undertaken and histopathological assessment confirmed a diffusely inflamed pituitary gland with dense chronic inflammatory cell infiltrates overall, consistent with a diagnosis of LH. Rather unexpectedly, the patient retained a regular menstrual cycle post-partum and conceived spontaneously one year later.
Conclusion: LH must be included in the differential diagnosis of any pituitary mass in pregnancy and/or the puerperium. Despite its rarity a high index of suspicion is required.

Introduction: Lymphocytic hypophysitis (LH) is a rare disease with an annual incidence of approximately one in ten million population. A subsequent pregnancy after pituitary surgery is even rarer.
Case Report:A 21-year-old primigravida who developed a sudden onset of headache and blurred vision at 35 weeks gestation. Formal examination at the local eye hospital revealed a bitemporal hemianopia and subsequent MRI indicated a pituitary mass with suprasellar extension and chiasmal compression. Transphenoidal endoscopic resection was undertaken and histopathological assessment confirmed a diffusely inflamed pituitary gland with dense chronic inflammatory cell infiltrates overall, consistent with a diagnosis of LH. Rather unexpectedly, the patient retained a regular menstrual cycle post-partum and conceived spontaneously one year later.
Conclusion: LH must be included in the differential diagnosis of any pituitary mass in pregnancy and/or the puerperium. Despite its rarity a high index of suspicion is required.

Keywords: Lymphocyitc hypophysitis, Pregnancy, pituitary, Transphenoidal surgery


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Author Contributions
Emma Jayne Thornton – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
S. Bonner – Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
K. Gnanalingham – Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
P. Pal – Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published J. Davis – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published L. M. Byrd – Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Guarantor of Submission
The corresponding author is the guarantor of submission.
Source of Support
None
Conflict of Interest
Authors declare no conflict of interest.
Copyright
© 2018 Emma Jayne Thornton et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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