Visual loss during pregnancy due to physiological pituitary hyperplasia

Physiological pituitary hyperplasia is due to adenohypophyseal cell number increase and is characterised by diffuse isodense pituitary enlargement beyond age-appropriate sizes. It most commonly occurs in females undergoing reproductive changes (puberty, pregnancy, menopause). We report a case of pituitary hyperplasia (pituitary height 14 mm) in a 33-year-old female presenting as vision changes at 34 weeks 'gestation. Computer visual fields identified right sided superotemporal visual field loss with current retinal nerve fibre layer assessment suggestive of compressive optic neuropathy. Serial visual assessment was performed, and due to progression, a caesarean section was performed at 38 weeks' gestation. Cabergoline was not utilised, and one month following delivery, visual findings had resolved, and pituitary height had reduced to 11 mm. There is limited data regarding management for pituitary hyperplasia causing compressive neuropathy irrespective of pregnancy. This case highlights the temporary nature of hypertrophy during pregnancy and positive visual outcome with conservative interventions.