# Severe Hyponatremia Secondary to Pituitary Macroadenoma With Internal Hemorrhage in the Postpartum Period: A Case Report

## TL;DR

A postpartum woman with a pituitary tumor and internal bleeding developed severe low sodium levels and vision issues, requiring multidisciplinary care for proper diagnosis and treatment.

## Contribution

Highlights the diagnostic challenges and management of pituitary apoplexy-induced hyponatremia in the postpartum period.

## Key findings

- Severe hyponatremia and visual changes in a postpartum woman were linked to a hemorrhagic pituitary macroadenoma.
- Multidisciplinary care involving endocrinology, neurosurgery, and ophthalmology was critical for effective management.
- Early recognition and treatment improved outcomes in this complex postpartum case.

## Abstract

Pituitary macroadenomas, especially those complicated by internal hemorrhage (pituitary apoplexy), can lead to severe endocrine dysfunction and visual disturbances. This is particularly challenging to diagnose in the postpartum period due to physiological changes associated with childbirth and breastfeeding. This case report aims to highlight the diagnostic and therapeutic complexities of managing severe hyponatremia and visual changes in a woman with a pituitary macroadenoma in the postpartum period.A 34-year-old female, five months postpartum, presented with a one-month history of intermittent nausea, headaches, and blurry vision, which worsened over the past week. Initial laboratory results revealed severe hyponatremia with a sodium level of 112 mEq/L. Imaging studies, including MRI, confirmed a 1.9 x 1.8 x 1.7 cm pituitary macroadenoma with internal hemorrhage exerting mass effect on the optic chiasm. The patient was managed with hypertonic saline for hyponatremia and empiric glucocorticoid supplementation for suspected adrenal insufficiency. A multidisciplinary approach involving endocrinology, neurosurgery, and ophthalmology was employed to address her complex medical needs. This case underscores the importance of considering pituitary pathology in women presenting with severe hyponatremia and visual changes postpartum. A multidisciplinary approach is essential for optimal management and prevention of long-term complications. Early recognition and appropriate intervention are crucial in ensuring a favorable outcome.