Pituitary Disease in Pregnancy: Special Aspects of Diagnosis and Treatment?

Abstract

The diagnosis and treatment of pituitary disease in pregnancy represents a special clinical challenge. Not least because there is very little data on the treatment of pregnant patients with pituitary disorders. A selective search of the literature was carried out with the aim of compiling evidence about the diagnosis and treatment of pituitary disease in pregnancy. The search covered the databases PubMed/MEDLINE including PubMed Central and also used the Livivo (ZB MED) search engine. Recent studies were evaluated for recommendations about the care of pregnant patients with hormone-inactive and hormone-active pituitary adenomas (prolactinoma, acromegaly and Cushingʼs disease), pituitary insufficiency, pituitary apoplexy and hypophysitis. The most well-established forms of treatment are for prolactinoma, due to the incidence of this disease and its impact on fertility. When pregnancy has been confirmed, prolactinoma treatment with dopamine agonists should be paused. Although microprolactinomas rarely increase significantly in size after the administration of dopamine agonists is discontinued, symptomatic tumor growth of macroprolactinomas can occur. In such cases, treatment with dopamine agonists can be resumed. If the primary tumor is large and the risk that it will continue to grow is high, it may be necessary to continue medical treatment from the start of pregnancy. If one of the partners has a pituitary disorder, it is often still possible for many couples to achieve their wish of having children if they receive medical support to plan and the pregnancy is carefully monitored. Given the complexity of pituitary disease, pregnant patients with pituitary disorders should be cared for and treated by a multidisciplinary team in centers specializing in the diagnosis and treatment of pituitary disease.

Management of hypopituitarism: a perspective from the Brazilian Society of Endocrinology and Metabolism

“…Importantly, fertility preservation strategies need to be discussed with the patient desiring conception before or during treatment. Additional pituitary deficiencies should be appropriately treated, particularly GH deficiency, which has been associated in some studies with poor pregnancy rates in patients with hypopituitarism (89). In men and women with HH, the approach to restoring fertility may include clomiphene citrate, human chorionic gonadotropin (hCG), human menopausal gonadotropin, or purified or recombinant FSH (88).…”

Neue Entwicklungen und Perspektiven in der Akromegalie

“…Eine weitere Patientengruppe, welche besonderer Aufmerksamkeit bedarf, sind Schwangere [13]. Hier besteht vor allem das Risiko, dass ein florider GH-Exzess einen Gestationsdiabetes und/oder eine arterielle Hypertonie begünstigen kann.…”

Outcomes of Patients with Macroprolactinoma Desiring Pregnancy: Follow-Up to 23 Years from a Single Center

“…When treatment of macroprolactinomas in reproductive-age women is considered, we do not only take into account the restoration of fertility, but we must also be aware of potential complications during pregnancy, and effects of therapy on the fetus. It may be necessary to continue dopamine agonists (DA) throughout pregnancy as the risk of tumor growth may increase in these patients [2][3][4][5]. For this reason, especially in selected patients, whose tumors are invasive or adjacent to the optic chiasm, it would be appropriate to continue DA therapy throughout pregnancy if they had no previous surgery or radiotherapy [2,6].…”