A Rare Case Report on Pituitary Microadenoma in Pregnancy

Pituitary Microadenoma in Pregnancy is a rare condition, especially when associated with pregnancy. This case report highlights the management of a pregnant patient with a pre-existing pituitary microadenoma. A 26-year-old female, G2A1, at 38 weeks + 1 day gestation with a previously existing microadenoma on treatment who paved the way to safe motherhood . 1.5 years earlier, she presented with bilateral galactorrhoea and an elevated serum prolactin level. She had been on cabergoline therapy since diagnosis , later omitted three months prior to conception , which was restarted after first trimester to avoid teratogenic effects and continued till seventh month of gestation. There were no complaints of neurological symptoms such as headache, visual disturbances, or signs of pituitary apoplexy. Her antenatal period was uneventful till she developed late onset pre-eclampsia ;non severe at 38 weeks of gestation. On examination, she was stable, with normal neurological and endocrinological findings. Investigations revealed a small pituitary microadenoma measuring 4mm x 3mm on MRI and elevated serum prolactin (95.66 ng/mL, prior to conception) Given the patient's preeclampsia and microadenoma, labor was induced, and a cesarean section was performed due to fetal distress. A healthy male infant was delivered with an Apgar score of 9 at 5 minutes and 8 at 1 minute. Postoperatively, the patient's recovery was uneventful. A multidisciplinary team, including obstetricians, anaesthetists, neurosurgeons, and endocrinologists, were involved in her care. The neurosurgery team recommended continued cabergoline therapy after 8 weeks postpartum, and to follow up with repeat MRI for further management. The patient was discharged on post-operative day four, with mother and baby in good health . On follow up day seven, suture removal done. Patient was in good health and breastfeeding her baby. Conclusion : Pituitary microadenomas are relatively uncommon during pregnancy, and the management requires careful monitoring with multidisciplinary approach at a tertiary care centre. This case emphasizes the need for thorough prenatal screening, early identification of potential complications, and individualized management to ensure favourable maternal and fetal outcomes. The role of cabergoline in managing prolactinomas during pregnancy and postpartum remains essential for long-term care, omitting in first trimester and eight weeks postpartum for breastfeeding after neurological opinion.