Okafor U V, Onwuekwe I O, Ezegwui H U
Department of Anaesthesia, University of Nigeria Teaching Hospital (Unth), Enugu, Nigeria.
Cases J. 2009 Sep 8;2:6350. doi: 10.1186/1757-1626-0002-0000006350.
A middle aged primigravida was managed at the University of Nigeria Teaching Hospital, Enugu, Nigeria for a pituitary macroadenoma. She was admitted at 33 weeks gestational age following a history of blurred vision and generalized headache, worse on bending down. After neurological consultation and investigations, a diagnosis of pituitary macroadenoma with mass effect was entertained. A plan for neurosurgery after delivery was made and the patient put on bromocriptine to reduce tumour size. Premature labour at 35 weeks resulted in caesarean delivery of a live baby. She was managed in the intensive care unit for three days where oral bromocriptine was resumed before she was transfered to the postnatal ward. Within ten hours of the transfer, she developed accelerated hypertension with encephalopathy and had a cardiac arrest shortly afterwards. This rare case highlights both the possible role of bromocriptine as a cause of postpartum hypertension and the possible development of a sudden catastrophic intramoural infarction or hemorrhage (pituitary apoplexy) in a patient with a macroadenoma.
一名中年初产妇在尼日利亚埃努古的尼日利亚大学教学医院接受垂体大腺瘤治疗。她在孕33周时因视力模糊和全身头痛病史入院，弯腰时症状加重。经过神经科会诊和检查，考虑诊断为有占位效应的垂体大腺瘤。制定了产后神经外科手术计划，并让患者服用溴隐亭以缩小肿瘤大小。孕35周时早产，通过剖宫产分娩出一名活婴。她在重症监护病房接受了三天治疗，在转至产后病房前恢复了口服溴隐亭。转至产后病房后十小时内，她出现了高血压急症伴脑病，随后不久发生心脏骤停。这个罕见病例既凸显了溴隐亭作为产后高血压病因的可能作用，也显示了大腺瘤患者可能发生突发性灾难性瘤内梗死或出血（垂体卒中）。
