Gestational Pituitary-Tumor Apoplexy

A 31-year-old woman with a history of prolactinoma was admitted at the 39th week of her first pregnancy for headache and nausea. She had been receiving bromocriptine until she became pregnant. The neurologic examination, which included a dilated fundus examination and visual-field screening, was normal. Magnetic resonance imaging (MRI), consisting of a T 2 -weighted image in the axial plane (Panel A) and a T 1 -weighted image in the midsagittal plane (Panel B), revealed an intrasellar mass with suprasellar extension (arrows) and fluid levels consistent with recent bleeding into the macroadenoma. These findings are typical of pituitary-tumor apoplexy. Pituitary-tumor . . .