Cases reported "Adenoma, Chromophobe"

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1/5. Symptomatic pituitary tumor enlargement after induced pregnancy. Case report.

    A case is presented and 11 others are reviewed in which symptomatic pituitary tumor enlargement occurred during pregnancies that resulted from induced ovulation. The syndrome is usually characterized by headache and visual disturbances with bitemporal visual field abnormalities, but may present with ocular muscle palsies. The cases are divided into two groups. The patients in one group had a shorter duration of amenorrhea (3.8 years), developed symptoms before the 14th week of pregnancy, and were usually treated by tumor removal. patients in the second group had a longer period of amenorrhea (10.2 years), developed symptoms after the 24th week of pregnancy, and their symptoms regressed with delivery of the infant. Tumor removal or termination of the pregnancy both resulted in resolution of symptoms. All pregnancies resulted in normal infants. This series provides guidelines for management of future cases.
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keywords = ovulation
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2/5. Effective bromocriptine treatment of a pituitary macroadenoma during pregnancy.

    A 32-year-old woman with 5 years of oligomenorrhea and 2 years of amenorrhea became pregnant after ovulation induced by clomiphene citrate, human menopausal gonadotropin, and human chorionic gonadotropin. Although there were no neurologic or ophthalmologic symptoms before pregnancy, ptosis and diplopia developed progressively from 14 weeks' gestation. Physical, radiologic, and laboratory examinations revealed hyperprolactinemia with pituitary macroadenoma. In an attempt to delay surgery, 7.5 mg bromocriptine was administered daily. The serum prolactin level was lowered and clinical symptoms improved with bromocriptine treatment. The pregnancy continued uneventfully and normal twins were born at 39 weeks' gestation. Two weeks after delivery, a transsphenoidal hypophysectomy was performed.
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keywords = ovulation
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3/5. Acute visual loss during pregnancy after bromocriptine-induced ovulation. The elusive tumor.

    The evaluation of patients complaining of amenorrhea with or without galactorrhea has been greatly enhanced by the availability of serum prolactin determinations and advances in diagnostic radiology. Likewise, the treatment of these patients with ergot derivative has resulted in the return of normal menses, and many pregnancies have been reported. The present report is of a patient with hyperprolactinemic amenorrhea-galactorrhea successfully treated with bromocriptine. A pregnancy followed resumption of menses, and a suprasellar cromophobeadenoma became manifest by producing blindness of the patient. The case is presented with recommendations for diagnosis and treatment.
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ranking = 4
keywords = ovulation
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4/5. growth of a prolactinoma during pregnancy. Case report and review.

    A patient with hyperprolactinaemia and anovulation is described. Ovulation was induced with bromocriptine and the ensuing pregnancy caused rapid deterioration of vision and neurosurgical intervention. The management of hyperprolactinaemic infertility and the complications occurring during pregnancy in these patients are discussed.
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keywords = ovulation
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5/5. Conservative management of a pituitary tumor during pregnancy following induction of ovulation with gonadotropins.

    Ovulation induced with human menopausal gonadotropin-human chorionic gonadotropin in a 27-year-old woman who had been amenorrheic for 7 years resulted in pregnancy. Although pretreatment neurologic evaluation was normal, significant loss of vision was found at 30 weeks' gestation, and a skull x-ray revealed enlargement and erosion of the sella turcica. As an attempt to delay surgery, 12 mg of dexamethasone daily arrested further visual deterioration, and the pregnancy continued uneventful for 36 weeks, when triplets were born. Five days after delivery the visual fields were normal. Trans-sphenoidal resection of a prolactin-secreting chromophobe adenoma of the pituitary was carried out 6 months later. It is suggested that when disturbance in visual perception due to a pituitary tumor occurs during pregnancy, a course of high-dose corticosteroids with frequent monitoring of visual fields and acuity might be tried before surgical intervention. Although further rapid deterioration in vision may dictate immediate surgical decompression, conservative management may result in stabilization, allowing the patient to carry the pregnancy to term and obviating the need for emergency surgery.
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ranking = 4
keywords = ovulation
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