A 20 year old Asian housewife presented with a history of irregular periods and six months subfertility. On May 1 2002 she had a prolactin of 2,200 mIU/L (normal range 63-211) and subclinical hyperthyroidism : thyroid stimulating hormone (TSH) 0.3mIU/L (normal range 0.4-5.5) and free thyroxine (fT4) 12.6 pmol/L (normal range 10.3-23.2). At her first hospital visit on September 9 2002 she was 9 weeks pregnant. She did not have hyperemesis gravidarum. On examination, she was clinically euthyroid but her thyroid was enlarged. She had no eye signs or extraocular muscle paralysis. Her visual fields were normal to confrontation and her fundi were normal. Her prolactin was now 4200 mIU/L. Random cortisol was 447 nmol/L. Magnetic resonance imaging (MRI) of the pituitary fossa at 21 weeks gestation showed an enlarged pituitary fossa with a subacute haematoma occupying most of the right side of the gland. The appearances were consistent with haemorrhage into a pre-existing microadenoma. There was no significant suprasellar extension and no chiasmatic compression. Throughout the remainder of the pregnancy she had visual fields (Goldmann perimetry) tested monthly which remained normal. Repeat thyroid function tests showed subclinical hyperthyroidism throughout the pregnancy (October 2 2002 : TSH 0.1 mIU/L ; fT4 21.2 pmol/L). She went into spontaneous labour at 40 weeks' gestation and gave birth to a healthy girl of weight 3.480 kg. Currently she is breast feeding and both mother and baby are well. On review of the literature we have not found another similar case.
This patient conceived without treatment despite significant hyperprolactinaemia. This report shows that in some women with pituitary apoplexy but favourable anatomical features on MRI, pregnancy and the postpartum period can be safe and uneventful.
03 - 05 Nov 2003
Society for Endocrinology