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Anesthetic Management of Parturient with Pituitary Macroadenoma
Abstract Number: SU-27
Abstract Type: Case Report/Case Series
Pituitary macroadenoma is a rare condition in pregnancy. Many aspects of management for the obstetrical patient with pituitary macroadenoma are unclear. Medical management is one area that has been established by the Endocrine Society (1). However, mode of delivery and anesthetic management are less clear. Successful cesarean sections and operative vaginal deliveries both have been reported (2, 3). For patients undergoing cesarean section arguments have been made for regional and general anesthesia. Both methods of anesthesia can increase intracranial pressure which has the potential for intracranial or subarachnoid hemorrhage (4).
We present a case of a 30 year old G2P1001 with enlarging and symptomatic pituitary macroadenoma treated with bromocriptine complicating her pregnancy. The patient underwent successful cesarean section at 37 weeks gestation under general anesthesia. On postoperative day one the patient was found to have worsening symptoms and imaging that demonstrated hemorrhagic changes and enlargement of the adenoma with compression of the optic chiasm and mass effect on Meckel’s cave. Subsequent removal of the mass was performed on post operative day three.
1. Shlomo Melmed, et al. “Diagnosis and Treatment of Hyperprolactinemia: An Endocrine Society Clinical Practice Guideline.” J Clin Endocrinol Metab 96 (2011), pp. 273–288.
2. Hye-Ran Lee, et al. “Developed diplopia and ptosis due to a nonfunctioning pituitary macroadenoma during pregnancy.” Obstet Gynecol Sci. 57 (2014) pp. 66–69.
3. Remadevi R, et al. “Epidural Anesthesia for Caesarean Section in a Pregnant Patient with Pituitary Macroadenoma.” Journal of Clinical and Diagnostic Research, 8 (2014)
4. Lars Wang, et al. “Neuroanesthesia for the Pregnant Woman.” Neurosurgical Anesthesiology 107 (2008), pp. 193-200