Concurrent Cerebral Thrombophlebitis and Nonfunctioning Pituitary Adenoma in a Postpartum Woman: A Rare Coexistence and Diagnostic Challenges

Case Report

Austin Gynecol Case Rep. 2023; 8(2): 1042.

Concurrent Cerebral Thrombophlebitis and Nonfunctioning Pituitary Adenoma in a Postpartum Woman: A Rare Coexistence and Diagnostic Challenges

Boubekri A¹*; Bellamlih H²; Ababou M¹; Atmani W¹; Meziane M¹; Jaafari A¹; Baite A¹; Bensghir M¹

¹Department of Anesthesiology and Intensive Care, Mohammed V University, Morocco

²Radiology Department, Moulay-Ismail Military Hospital, Meknes, Sidi Mohamed Ben Abdellah University, Fez, Morocco

*Corresponding author: Boubekri Ayoub Department of Anesthesiology and Intensive Care, Mohammed V University, Morocco. Email: dr.boubkri@gmail.com

Received: July 03, 2023Accepted: August 05, 2023 Published: August 13, 2023

Abstract

This case report presents a rare occurrence of concurrent cerebral thrombophlebitis and nonfunctioning pituitary adenoma in a postpartum woman. Cerebral thrombophlebitis is a rare condition that can manifest with diverse clinical presentations, posing diagnostic challenges. The patient, a 30-year-old primipara, presented with progressive vision loss, diplopia, and intense frontal headaches shortly after childbirth. Magnetic resonance angiography revealed thrombophlebitis in the right lateral sinus extending into the ipsilateral internal jugular vein, along with a large suprasellar lesion suggestive of a pituitary macroadenoma. Ophthalmological examination revealed papilledema and ptosis. Laboratory analyses ruled out hormonal abnormalities associated with pituitary adenomas. The patient received intravenous methylprednisolone and therapeutic anticoagulation, resulting in neurological and ophthalmological improvements. Subsequently, the patient underwent transsphenoidal resection. This case highlights the diagnostic and management challenges associated with rare postpartum conditions and emphasizes the importance of comprehensive evaluation and multidisciplinary care in such cases.

Keywords: Cerebral thrombophlebitis; Postpartum; Nonfunctioning pituitary adenoma

Introduction

Cerebral thrombophlebitis is a rare but severe condition that can occur during pregnancy and the postpartum period. It is characterized by a diverse range of clinical presentations, including headaches, seizures, and neurological deficits. The diagnosis of cerebral thrombophlebitis relies heavily on neuroradiological imaging, particularly cerebral Magnetic Resonance Imaging (MRI). Treatment primarily involves the administration of anticoagulant therapy. However, the rarity of postpartum cerebral thrombophlebitis poses significant diagnostic challenges due to its variable symptomatology.

In addition to cerebral thrombophlebitis, other conditions may also manifest during the postpartum period. One such condition is Nonfunctioning Pituitary Adenoma (NFPA), which refers to infrequent tumors occurring in women of reproductive age. NFPA cases diagnosed and complicated during pregnancy are extremely rare. During pregnancy, the pituitary gland undergoes anatomical and physiological changes, with a significant increase in size observed. However, symptoms such as blurred vision and headaches resulting from physiological enlargement of the pituitary gland are uncommon.

This article aims to present a rare case of a postpartum woman diagnosed with concurrent cerebral thrombophlebitis and nonfunctioning pituitary adenoma. The coexistence of these two conditions in the same individual is exceedingly rare. By providing a detailed account of this unique case, we aim to contribute to the existing scientific knowledge and raise awareness about the diagnostic and management challenges associated with these conditions in the postpartum period.

Observation

A 30-year-old woman, 55 days postpartum, was admitted to the Neurology Department of the military hospital for the management of intracranial hypertension syndrome. The patient had no significant medical history and was a primipara with regular menstrual cycles before pregnancy, without headaches or visual deficits. Symptoms started immediately in the postpartum period with progressive vision loss, onset of diplopia, and intense frontal headaches refractory to symptomatic treatment. Given the context and timing of symptom onset, cerebral thrombophlebitis was suspected, leading to neuroimaging investigations, including magnetic resonance angiography (Figure 1), which revealed right lateral sinus thrombophlebitis extending into the ipsilateral internal jugular vein and a large suprasellar lesion suggestive of a pituitary macroadenoma. Ophthalmologic examination showed visual acuity of 8/10 in the right eye and the presence of ptosis. Fundoscopy revealed stage 1 papilledema. Laboratory analyses were normal for thyroid axis function, and prolactin levels were within normal range for the postpartum period. There were no symptoms of diabetes insipidus, and there were no signs or symptoms of excess Growth Hormone (GH) or cortisol, indicating a non-functioning pituitary adenoma incidentally discovered during the investigation of cerebral thrombophlebitis.

Citation: Boubekri A, Bellamlih H, Ababou M, Atmani W, Meziane M, et al. Concurrent Cerebral Thrombophlebitis and Nonfunctioning Pituitary Adenoma in a Postpartum Woman: A Rare Coexistence and Diagnostic Challenges. Austin Gynecol Case Rep. 2023; 8(2): 1042.