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Hyponatremia associated coma due to pituitary apoplexy in early pregnancy: a case report

Ina Krull1, Emanuel Christ, Christian Philipp Kamm

  • 1Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Bern, Bern, Switzerland. ina.krull@insel.ch

Gynecological Endocrinology : the Official Journal of the International Society of Gynecological Endocrinology
|November 18, 2009
PubMed

Pituitary apoplexy in pregnancy is rare. Its clinical features may range from unspecific complaints to panhypopituitarism resulting even in coma and death. Therefore, alertness to signs and symptoms of acute loss of pituitary function in pregnancy is mandatory. We report a woman in her 7th week of her first gestation presenting with sudden coma due to severe hyponatremia. Secondary adrenal insufficiency could be identified as the underlying cause. Panhypopituitarism including central diabetes insipidus and spontaneous abortion developed during the follow-up. Magnetic resonance imaging showed pituitary apoplexy without a pre-existing pituitary mass. The clinical course was notable for severe complications, including neurological deficits through cerebral ischemia, but eventual recovery could be achieved. We discuss the diagnostic difficulties in the evaluation of pituitary disease in pregnancy.

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