Neuroendocrinology and Pituitary

MON-100 - Transient Postpartum Pituitary Enlargement Mimicking Macroadenoma

Monday, June 15, 2026

9:00 AM - 2:00 PM CT

Location: ENDOExpo; Poster Floor

Abstract Poster Presenter(s)

AI

Ahmed A. Ismail, MD

Hamilton Medical center
Dalton, Georgia, United States

Co-Author(s)

Ibrahim Hamad, MD

Hamilton Medical Center
Dalton, GA, United States
Jacqueline Silvia Martins Torrontegui, MD

IM Resident
Hamilton Medical Center
Dalton, GA, United States
Punerdeep S. Sidhu, MD (he/him/his)

MD
Hamilton Medical Center
Dalton, GA, United States
Aseel Abualnil, MD

IM resident
Hamilton Medical Center
Dalton, GA, United States
AB

Ami Bhalodia, MD

Resident Physician
Hamilton Medical Center
DALTON, Georgia, United States

Senior Author/Primary Investigator(s)

CP

Carlos Penaherrera, MD

Hamilton Health Care System
dalton, Georgia, United States

Co-Author(s)

CP

Carlos Penaherrera, MD

Hamilton Health Care System
dalton, Georgia, United States

Disclosure(s):

Ibrahim Hamad, MD: No financial relationships to disclose

Jacqueline Silvia Martins Torrontegui, MD: No financial relationships to disclose

Punerdeep S. Sidhu, MD: No financial relationships to disclose

Aseel Abualnil, MD: No financial relationships to disclose

Background:
Physiologic pituitary enlargement occurs during pregnancy due to estrogen-mediated lactotroph hyperplasia, typically remaining < 10 mm and regressing after delivery. Rarely, this enlargement can exceed the macroadenoma threshold and mimic a sellar mass. Recognition of this benign process is essential to avoid unnecessary intervention.

Case:
A 35-year-old woman, five days postpartum, presented with severe, progressively worsening headaches unrelieved by over-the-counter analgesics. She denied nausea, vomiting, and visual disturbances and was not breastfeeding. MRI revealed a 1.1 × 1.4 × 1.2 cm sellar mass extending into the suprasellar cistern and contacting the optic chiasm, raising concern for a pituitary macroadenoma. A prior MRI from four years earlier was normal.
Pituitary hormonal evaluation was unremarkable except for mildly decreased free T4 (0.78 ng/dL), and levothyroxine therapy was initiated. No hormonal hypersecretion or hypopituitarism was identified. The patient was managed conservatively with close follow-up.
Repeat MRI two months later demonstrated complete resolution of the enlargement, revealing a normal-sized pituitary gland measuring 4 × 8 mm. Headaches fully resolved, and she remained clinically stable on low-dose levothyroxine.

Conclusion:
This case highlights a transient physiologic postpartum pituitary enlargement that radiographically resembled a macroadenoma. Potential mechanisms include marked lactotroph hyperplasia, autoimmune-mediated hypophysitis, or transient postpartum ischemic edema. Awareness of this phenomenon is critical to prevent unnecessary neurosurgical evaluation or overtreatment. In postpartum patients with new-onset pituitary enlargement, conservative management with endocrine follow-up and repeat imaging should be strongly considered.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*