Pregnancy and pituitary disorders: Challenges in diagnosis and management

Abstract

Pregnancy is associated with normal physiological changes in endocrine system that assists fetal survival as well as preparation of labor. The pituitary gland is one of the most affected organs in which major changes in anatomy and physiology take place. Due to overlapping clinical and biochemical features of pregnancy, sometimes the diagnosis of pituitary disorders may be challenging. It is important to know what normal parameters of changes occur in endocrine system in order to diagnose and manage complex endocrine problems in pregnancy. In our present review, we will focus on pituitary disorders that occur exclusively during pregnancy like Sheehan's syndrome and lymphocytic hypophysitis and pre-existing pituitary disorders (like prolactinoma, Cushing's disease and acromegaly), which poses significant challenge to endocrinologists.

Update on prolactinomas. Part 2: Treatment and management strategies

“…However, cabergoline is more costly than bromocriptine, so from a financial perspective, bromocriptine is a reasonable choice [29]. While bromocriptine is the drug of choice in pregnancy, recent studies are also confirming the safety of cabergoline use during pregnancy as well [19,29,30]. The Endocrine Society now recommends cabergoline as a first line treatment for patients with prolactinomas, placing a lower value on the cost of treatment and a higher value on patient convenience [31].…”

“…Estrogen from the placenta causes hypertrophy of lactotrophs and stimulates prolactin secretion [30]. Therefore, prolactin levels may increase in women, even without a prolactinoma.…”

“…During pregnancy, the weight of the pituitary gland increases by one third, along with many other anatomical and physiological changes [30]. Estrogen from the placenta causes hypertrophy of lactotrophs and stimulates prolactin secretion [30].…”

Cabergoline use for cushing’s disease during pregnancy: Mini review

“…Pregnancy rarely occurs in a patient with Cushing's syndrome (CS), due to the effect of hypercortisolism on the reproductive axis [1][2][3]. To date, approximately 263 cases of Cushing's syndrome have been reported in the literature [4].…”

MODERN APPROACHES TO THERAPY CUSHING’S DISEASE (review)

“…Данная патология относится к классу редких заболеваний, возникает в молодом возрасте (20-40 лет), соотношение женщин и мужчин состав-ляет 3,5/1,0 [3]. Основными причинами преждевременной смерти больных с БИК являются кардиоваскулярные (29 %), це-реброваскулярные (11 %) и инфекционные (12 %) осложнения [4].…”