Prolactinoma and pregnancy

Visual loss in pregnancy

Visual loss in pregnancy may be caused by a variety of reasons including pituitary adenomas. Prolactinomas (PRLs) are the most common hormone-secreting tumours in pregnant women. As most PRLs present with menstrual abnormalities, infertility or galactorrhoea, they are most commonly diagnosed before pregnancy. We present the case of a 30-year-old primigravida who presented at 36⁺⁵ weeks gestation with headaches and left-sided visual loss. MRI of the pituitary gland confirmed a 10×11 mm left suprasellar mass. Results of her anterior pituitary function were unremarkable for her gestational age. Postpartum, she underwent an endoscopic endonasal resection of the pituitary tumour. The histology was consistent with a PRL. Literature review reveals only one possible case of a new diagnosis of a PRL during pregnancy. It highlights the importance to consider a wide range of differential diagnoses when assessing visual loss in pregnancy.

Rat models of 17β-estradiol-induced mammary cancer reveal novel insights into breast cancer etiology and prevention

Numerous laboratory and epidemiologic studies strongly implicate endogenous and exogenous estrogens in the etiology of breast cancer. Data summarized herein suggest that the ACI rat model of 17β-estradiol (E2)-induced mammary cancer is unique among rodent models in the extent to which it faithfully reflects the etiology and biology of luminal types of breast cancer, which together constitute ~70% of all breast cancers. E2 drives cancer development in this model through mechanisms that are largely dependent upon estrogen receptors and require progesterone and its receptors. Moreover, mammary cancer development appears to be associated with generation of oxidative stress and can be modified by multiple dietary factors, several of which may attenuate the actions of reactive oxygen species. Studies of susceptible ACI rats and resistant COP or BN rats provide novel insights into the genetic bases of susceptibility and the biological processes regulated by genetic determinants of susceptibility. This review summarizes research progress resulting from use of these physiologically relevant rat models to advance understanding of breast cancer etiology and prevention.

An unusual presentation of a pituitary tumour in the early postpartum period

The case of a parturient, who first presented with a partial oculomotor nerve palsy shortly after caesarean delivery while participating in a clinical trial, is presented. The anaesthesia for the caesarean delivery involved a combined spinal-epidural with intrathecal bupivacaine and postoperative epidural pethidine patient-controlled analgesia. The trial was examining the possible effects of magnesium infusions on acute and chronic pain. The partial oculomotor nerve palsy was an unusual presentation and the signs and symptoms were transient. Magnetic resonance imaging confirmed the presence of a presumed pituitary macroadenoma. Possible reasons for the timing of onset and the rapid resolution of symptoms, and the implications and management of pituitary pathology in the peripartum period, are considered. The uncomplicated course of a later caesarean delivery in the same patient, using the same anaesthesia technique, is also noted.