Pituitary Adenoma in Pregnant Patient with Acute Visual Loss: Clinical Case Report

A.Y. Lubnin1, P.L. Kalinin1, D.V. Fomichev1, K.N. Ahvlediani2, N.M. Eliseeva1, O.F. Tropinskaya1, L.I. Astaf’eva1

1FGAU NII «N.N. Burdenko Neurosurgery Institute» MZ RF, Moscow

2GBUZ MO «Moscow Regional Research Institute of Obstetrics and Gynecology», Moscow

For correspondence: Lubnin Andrei Yurevich — Head of Anesthesiology, Intensive Care Department FGAU NII «N.N. Burdenko Neurosurgery Institute» MZ RF; e-mail: lubnin@nsi.ru

For citation: Lubnin AY, Kalinin PL, Fomichev DV, Akhvlediani KN, Eliseev NM, Tropinskaya OF, Astaf’eva LI. Pituitary Adenoma in Pregnant Patient with Acute Visual Loss: Clinical Case Report. Intensive Care Herald. 2016;4:67–71.


We present patient with pituitary adenoma (prolactinoma) which manifested by dramatic decrease of visual function as a consequence of apoplexy during pregnancy. We decided to operate patient on hypophysis with preserved pregnancy. In conclusion we discus problem of brain tumor management in pregnant patients and anesthetic managements of such patients.

Keywords: pituitary adenoma, pregnancy, anesthetic management

Received: 05.11.2016


References

  1. Астафьева Л.И., Кадашев Б.А., Калинин П.Л. и др. Клиническая картина, диагностика и результаты первичной медикаментозной терапии больших и гигантских пролактинсекретирующих аденом гипофиза. Вопр. нейрохир. 2008; 4: 36–39. [Astaf’eva L.I., Kadashev B.A., Kalinin P.L. et al. Klinicheskaya kartina, diagnostika i rezul’taty pervichnoi medikamentoznoi terapii bol’shih i gigantskih prolaktinsekretiruyuschih adenom gipofiza. Vopr. neirohir. 2008; 4: 36–39. (In Russ)]
  2. Кадашев Б.А. Аденомы гипофиза. Тверь: Триада, 2007. [Kadashev B.A. Adenomy gipofiza. Tver: Triada, 2007. (In Russ)]
  3. Калинин П.Л., Фомичев Д.В., Кадашев Б.А. и др. Методика эндоскопической эндоназальной транссфеноидальной аденомэктомии. Вопр. нейрохир. 2007; 4: 42–45. [Kalinin P.L., Fomichev D.V., Kadashev B.A. et al. Metodika endoskopicheskoi endonazal’noi transsfenoidal’noi adenomektomii. Vopr. neirohir. 2007; 4: 42–45. (In Russ)]
  4. Калинин П.Л., Фомичев Д.В., Кутин М.А. и др. Эндоскопическая эндоназальная хирургия аденом гипофиза (опыт 1700 операций). Вопр. нейрохир. 2012; 3: 26–33. [Kalinin P.L., Fomichev D.V., Kutin M.A. et al. Endoskopicheskaya endonazal’naya hirurgiya adenom gipofiza (opyt 1700 operatsii). Vopr. neirohir. 2012; 3: 26–33. (In Russ)]
  5. Салова Е.М., Лубнин А.Ю., Цейтлин А.М. и др. Мониторинг глубины анестезии у нейрохирургических больных. Анест. и реан. 2011; 4: 22–27. [Salova E.M., Lubnin A.Yu., Tseitlin A.M. et al. Monitoring glubiny anestezii u heirohirurgicheskih bol’nyh. Anest. i rean. 2011; 4: 22–27. (In Russ)]
  6. Barlas O., Bayindir C., Hepgul K. et al. Bromocriptine-induced cerebrospinal fluid fistula in patiemts with macroprolactinomas: report of three cases and a review of the literature. Neurol. 1994; 41: 486–489.
  7. Cappell M.S. Sedation and analgesia for gastrointestinal endoscopy during pregnancy. Endosc. Clin. N. Am. 2006; 16: 1–31.
  8. Chen M.M., Coakley F.V., Kaimal A. et al. Guidelines for computer tomography and magnetic resonance imaging use during pregnancy and lactation. Gunecol. 2008; 112: 333–340.
  9. Chiodini I., Losa M., Pavone G. et al. Pregnancy in a Cushing’s disease shortly after treatment by gamma-knife radiosurgery. Endocrinol. Invest. 2004; 27: 954–956.
  10. Dyamanna D.N., Bhakta P., Chouhan R.S. et al. Anesthetic management of a patient with pituitary adenoma for cesarean section. J. Obstet. Anesth. 2010; 19: 460–461. doi: 10.1016/j.ijoa.2010.04.006.
  11. Gist R.S., Beilin Y. The effect of anesthetic drugs on the developing fetus: considerations in nonobstetric surgery. In: Ginosar Y.F., Halpern R.S., Weiner C.P. (Eds.) Anesthesia and the fetus. UK: Wiley-Blackwell, 2013: 156–164.
  12. Grinberg M.S. Handbook of Neurosurgery, 7th Ch. 21. NY: Thieme, 2010: 582–749.
  13. Jezkova J., Marek J., Hana V. et al. Gamma knife radiosurgery for acromegaly — long-term experience. Endocrinol. 2006; 64: 588–595. doi: 10.1007/s11102-014-0584-7.
  14. Jezkova J., Hana V., Krsek M. et al. Use of the Leksell gamms knife in the treatment of prolactinoma patients. Endocrinol. 2009; 70: 732–741. doi: 10.1111/j.1365-2265.2008.03384.x.
  15. Karabulut A.K., Reisli R., Uysal I.I. et al. An investigation of non-depolarizing muscle relaxants on embryonic development in cultured rat embryos. J. Anaesthesiol. 2004; 21: 715–724.
  16. Kurdoglu Z., Cetin O., Gulsen I. et al. Intracranial meningeoma diagnosed during pregnancy caused maternal death. Case Rep. Med. 2014; 2014: 158326. doi: 10.1155/2014/158326.
  17. Landolt A.M., Lomax N. Gamma knife radiosurgery for prolactinomas. Neurosurg. 2000; 93(Suppl3): 14–18. doi: 10.3171/jns.2000.93.supplement.
  18. Leong K.S., Foy P.M., Swift A.C. et al. CSF rhinorrhea following treatment with dopamine agonists for massive invasive prolactinomas. Endocrinol. 2000; 52: 43–49.
  19. Martin L.V., Jurand A. The absence of teratogenic effects of some analgesics used in anesthesia. Additional evidence from a mouse model. Anaesthesia. 1992; 47: 473–476.
  20. Moscovici S., Fraifeld S., Cohen J.E. et al. Parasellar meningeomas in pregnancy: surgical results and visual outcomes. World Neurosurg. 2014; 82: e503–e512. doi: 10.1016/j.wneu.2013.06.019.
  21. Nosek E., Ekstein M., Rimon E. et al. Neurosurgery and pregnancy. Acta Neurochir. 2011; 153: 1727–1735. doi: 10.1007/s10143-015-0608-4.
  22. Nosek E., Ekstein M., Barklay G. et al. Visual deterioration during pregnancy due skull base tumors compressing the optic apparatus. Rev. 2015; 38: 473–479.
  23. Olivi A., Brem R.F., McPherson R., Brem H. Brain Tumors in pregnancy, In: Goldstein P.J., Stern B.J. (Eds.) Neurological disorders of pregnancy, 2nd NY: Futura Publishing Co., 1992: 85–105.
  24. Palamisamy A. Maternal anesthesia and fetal neurodevelopment. Int. J. Obstet. Anesth. 2012; 21: 152–162. doi: 10.1016/j.ijoa.2012.01.005.
  25. Powel M. Pituitary tumors and pregnancy. Acta Neurochir. 2011; 153: 1737–1738.
  26. Shah P.N., Sonawane D., Appukutty J. Anaesthetic management for cesarean section in a case of previously operated with residual pituitary tumor. Indian J. Anaesth. 2011; 55: 618–620. doi: 10.4103/0019-5049.90623.
  27. Terry A.R., Barker F.G., Leffelt L. et al. Outcomes of hospitalization in pregnant women with CNS neoplasms: a population based study. 2012; 14: 768–776. doi: 10.1093/neuonc/nos078.
  28. Wu J., Ma Y.-A., Wang T.-L. Glioma in the third trimester of pregnancy: Two cases and review of the literature. Lett. 2013; 5: 943–946. doi: 10.3892/ol.2013.1106.
  29. Zhang N., Pan L., Dai J. et al. Gamma knife radiosurgery as a primary surgical treatment for hypersrcreting pituitary adenomas. Funct. Neurosurg. 2000; 75: 123–128.