TO THE EDITOR:
The article by Kupersmith and colleagues [1] does not mention the findings from magnetic resonance imaging and computed tomography scans in their patients with macroadenoma of the pituitary gland and visual field defects. A hemorrhagic pituitary adenoma during pregnancy may cause an acute increase in the size of the macroadenoma and may cause visual field defects. On the basis of magnetic resonance imaging scans, such pituitary "apoplexy" has been classified as classical, subacute, and asymptomatic [2]. Further, the density of the pituitary adenoma may give an idea of the acuteness of the apoplexy and help distinguish a neoplastic process from a non-neoplastic process [2, 3].
Why did none of the 6 of 8 patients with pituitary macroadenoma who had documented visual field defects have surgical intervention during their pregnancy? Trans-sphenoidal surgical resection of pituitary adenomas during pregnancy is a safe procedure and is the treatment of choice in patients with visual field involvement [4, 5].
1. Kupersmith MJ, Rosenberg C, Kleinberg D. Visual loss in pregnant women with pituitary adenomas. Ann Intern Med. 1994; 121:473-7.
2. Kannuki S, Bando K, Sirakawa N, Matsumoto K, Bando H, Saito S, et al. MRI findings and endocrinological dysfunction in hemorrhagic pituitary adenoma. Neurological Surgery. 1993; 21:1005-12.
3. Hua F, Asato R, Miki Y, Okumura R, Hashimota N, Kikuchi H, et al. Differentiation of suprasellar nonneoplastic cysts from cystic neoplasms by Gd-DTPA MRI. J Comput Assist Tomogr. 1992; 16:744-9.
4. Coyne TJ, Atkinson RL, Prins JB. Adrenocorticotropic hormone-secreting pituitary tumor associated with pregnancy: case report. Neurosurgery. 1992; 31:953-5.
5. Ohtsubo T, Asakura T, Kadota K, Takasaki K, Uchimura K, Makiuchi T, et al. A report of a trans-sphenoidal operation during pregnancy for a pituitary adenoma. Neurological Surgery. 1991; 19:867-70.
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