Concomitant Pituitary Apoplexy and Acute Fatty Liver of Pregnancy Complicated With Disseminated Intravascular Coagulation

ABSTRACT Objective: Pituitary complications during delivery are relatively rare in developed countries. In this case report we describe a case of panhypopituitarism during pregnancy with concomitant acute liver failure. Methods: We present the case of a pregnant female with acute fatty liver of pregnancy (AFLP) complicated by panhypopituitarism. We also review the current literature on cases of anterior pituitary hormone deficiencies with AFLP, including presentation, management, and outcomes. Results: A 29 year-old female at 25-weeks gestation presented with subacute onset of headache accompanied by nausea and vomiting. She was diagnosed with acute liver failure and coagulopathy secondary to disseminated intravascular coagulation (DIC). Further workup revealed deficiencies of all anterior pituitary hormones, and magnetic resonance imaging (MRI) of the brain was compatible with pituitary hemorrhage/apoplexy from probable infarction. Conclusion: AFLP, especially in association with DIC, can lead to pituitary apoplexy and panhypopituitarism related to underlying coagulopathy. Given the high mortality rates associated with pituitary apoplexy, clinical awareness and a high index of suspicion are important for diagnosing this condition. Prompt initiation of hormone replacement therapy is essential to reduce morbidity and mortality risk. Abbreviations: AFLP acute fatty liver of pregnancy DIC disseminated intravascular coagulation MRI magnetic resonance imaging