{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T01:37:30Z","timestamp":1790300250120,"version":"4.1.0"},"reference-count":120,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T00:00:00Z","timestamp":1683763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Our purpose is to provide new insights concerning the challenges of pituitary apoplexy in pregnancy (PAP) and the postpartum period (PAPP). This is a narrative review of the English literature using a PubMed search. The inclusion criteria were clinically relevant original studies (January 2012\u2013December 2022). Overall, we included 35 original studies: 7 observational studies (selected cases on PA) and 28 case reports, including 4 case series (N = 49; PAP\/PAPP = 43\/6). The characteristics of PAP patients (N = 43) are as follows: maternal age between 21 and 41 (mean of 27.76) years; 21\/43 subjects with a presentation during the third trimester (only one case during first trimester); average weak of gestation of 26.38; most females were prim gravidae; 19 (out of 30 patients with available data on delivery) underwent a cesarean section. Headache remains the main clinical feature and is potentially associated with a heterogeneous panel (including visual anomalies, nausea, vomiting, cranial nerve palsies, diabetes insipidus, photophobia, and neck stiffness). Pre-pregnancy medication included dopamine agonists (15\/43) and terguride (1\/43) in addition to subsequent insulin therapy for gestational diabetes (N = 2) and type 1 diabetes mellitus (N = 1). Overall, 29\/43 females received the conservative approach, and 22\/43 women had trans-sphenoidal surgery (TSS) (and 10\/22 had the initial approach). Furthermore, 18\/43 patients had a pituitary adenoma undiagnosed before pregnancy. Most PA-associated tumors were prolactinomas (N = 26\/43), with the majority of them (N = 16\/26) being larger than 1 cm. A maternal\u2013fetal deadly outcome is reported in a single case. The characteristics of PAPP patients (N = 6) are as follows: mean age at diagnosis of 33 years; 3\/6 subjects had PA during their second pregnancy; the timing of PA varied between 5 min and 12 days after delivery; headache was the main clinical element; 5\/6 had no underlying pituitary adenoma; 5\/6 patients were managed conservatively and 1\/6 underwent TSS; pituitary function recovered (N = 3) or led to persistent hypopituitarism (N = 3). In conclusion, PAP represents a rare, life-threatening condition. Headache is the most frequent presentation, and its prompt distinction from other conditions associated with headache, such as preeclampsia and meningitis, is essential. The index of suspicion should be high, especially in patients with additional risk factors such as pre-gestation treatment with dopamine agonists, diabetes mellitus, anticoagulation therapy, or large pituitary tumors. The management is conservative in most cases, and it mainly includes corticosteroid substitution and dopamine agonists. The most frequent surgical indication is neuro-ophthalmological deterioration, although the actual risk of pituitary surgery during pregnancy remains unknown. PAPP is exceptionally reported. To our knowledge, this sample\u2013case series study is the largest of its kind that is meant to increase the awareness to the benefit of the maternal\u2013fetal outcomes from multidisciplinary insights.<\/jats:p>","DOI":"10.3390\/jcm12103416","type":"journal-article","created":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T01:05:10Z","timestamp":1683853510000},"page":"3416","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Challenges of Pituitary Apoplexy in Pregnancy"],"prefix":"10.3390","volume":"12","author":[{"given":"Ana-Maria","family":"Gheorghe","sequence":"first","affiliation":[{"name":"Department of Endocrinology, \u201cC.I. Parhon\u201d National Institute of Endocrinology, 011683 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra-Ioana","family":"Trandafir","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Doctoral School of \u201cCarol Davila\u201d University of Medicine and Pharmacy, \u201cC.I. Parhon\u201d National Institute of Endocrinology, 011683 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela","family":"Stanciu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Faculty of Medicine, \u201cLucian Blaga\u201d University of Sibiu, 50169 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9834-3380","authenticated-orcid":false,"given":"Florina Ligia","family":"Popa","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Faculty of Medicine, \u201cLucian Blaga\u201d University of Sibiu, 550169 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2274-5666","authenticated-orcid":false,"given":"Claudiu","family":"Nistor","sequence":"additional","affiliation":[{"name":"Department 4\u2014Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy & Thoracic Surgery Department, \u201cDr. Carol Davila\u201d Central Emergency University Military Hospital, 013058 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8585-3835","authenticated-orcid":false,"given":"Mara","family":"Carsote","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, \u201cCarol Davila\u201d University of Medicine and Pharmacy & \u201cC.I. Parhon\u201d National Institute of Endocrinology, 011683 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s12020-014-0359-y","article-title":"Pituitary apoplexy","volume":"48","author":"Bi","year":"2015","journal-title":"Endocrine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s11916-019-0798-5","article-title":"Presentation and Management of Headache in Pituitary Apoplexy","volume":"23","author":"Suri","year":"2019","journal-title":"Curr. Pain Headache Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.nec.2019.06.001","article-title":"Pituitary Apoplexy","volume":"30","author":"Barkhoudarian","year":"2019","journal-title":"Neurosurg. Clin. N. 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