///2009 Abstract Details
2009 Abstract Details2019-08-03T15:55:31-06:00

Pituitary apoplexy in pregnany - A case report

Abstract Number: 66
Abstract Type: Case Report/Case Series

Lakshmanan Radhakrishnan MBBS, MD, FRCA1 ; Lakshmanan Radhakrishnan MBBS, MD, FRCA2; Austin Mathews MBBS, MD, FRCA3; Helen Brooks MBChb FRCA4; Susan Coley MBChb FRCA5

Case Report:A 32 year old primigravida presented at 33 weeks gestation with a history of severe sudden onset headache. Her general physical examination was normal with no abnormal neurological findings. Fundoscopy was normal. An MRI scan was performed and this showed a small posterior pituitary haemorrhage.The neurosurgical opinion was to manage conservatively. In view of clinical symptoms suggestive of raised intracranial pressure (ICP) and the radiological finding of a pituitary bleed, a decision was taken to deliver by elective caesarean section under general anaesthesia with invasive blood pressure monitoring.The patient was fasted preoperatively and given antacid prophylaxis.A16G cannula was sited and monitoring was established(SpO2, ECG and invasive blood pressure).After preoxygenation, alfentanil was given followed by thiopentone then rocuronium. Cricoid pressure was applied on loss of consciousness and endotracheal intubation was achieved easily. The patients blood pressure (BP) remained stable during intubation.Anaesthesia was maintained with sevoflurane and end- tidal CO2 of 4.5 kPa was maitained. A healthy baby was delivered with Apgar scores of 8 and 10 at 1 and 5 min.The rest of the surgery was uneventful.Labetolol was used to suppress extubation response.Discussion: There have been only a few case reports in the literature of pituitary apoplexy presenting during pregnancy(1). Pituitary apoplexy classically presents with sudden onset of headache, vomiting, visual disturbances and meningism although our patient presented only with headache and vomiting. It has been associated with significant morbidity and even mortality if not recognised in time.The anaesthetic management of these cases are complicated by the presence of raised ICP, risk of pituitary rebleed and associated panhypopituitarism. Regional techniques are generally contraindicated in the presence of raised ICP. General anaesthesia also carries the risk of a hypertensive response during laryngoscopy, intubation and extubation.There are various pharmacological measures that have been successfully used to suppress extubation but our choice was to use labetolol. the obstetric anaesthesia team was involved in timely fashion, allowing discussion with colleagues, inclincluding those in another centre also involved with neuro-anaesthesia. References:1.De Heide LJM, Van Tol KM., Doorenbos B. Pituitary apoplexy presenting during pregnancy. Netherland Journal of Medicine 2004; 62: 393-6

SOAP 2009