Background and aims In the literature, there are reported cases of pituitary apoplexy following spinal anaesthesia or accidental dural puncture following epidurals. This case report aims to highlight the anaesthetic considerations when managing a pregnant patient with pituitary macroadenoma during the peripartum period.
Methods Informed consent for publication has been obtained from patient.
Results A 33 year-old primigravida was diagnosed with pituitary macroadenoma during her first trimester when she presented with bitemporal hemianopsia. There was no immediate neurosurgical intervention required for her condition. Bromocriptine and thyroxine replacement was started in second trimester. the patient was under the care of neurosurgery, endocrine, ophthalmology, obstetrics and anaesthesia throughout her pregnancy and was well for the rest of her pregnancy with no worsening of her visual field defect. the neurosurgical and obstetric team agreed to let the patient undergo normal vaginal delivery at 40 weeks gestation. the anaesthetic goal for this patient was to avoid hypertension or hypotension in order to minimise the risk of haemorrhagic or ischaemic pituitary apoplexy. After adequate counselling, epidural was chosen for labour analgesia to avoid excessive hypertension during labour. With lumbar epidural, adequate pain control was established and baby was delivered uneventfully. Close neurological monitoring of the patient was performed post-delivery. Patient was discharged well on the next day and was followed up by neurosurgery.
Conclusions Management of parturient with pituitary macroadenoma involves a multidisciplinary team approach. the anaesthetic management should address the various maternal and foetal needs by maintaining stable systemic, cerebral and placental haemodynamic and to avoid raised intracranial pressure.
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