Surgical indications for pituitary tumors during pregnancy: a literature review

Graillon, Thomas; Cuny, Thomas; Castinetti, Frédéric; Courbière, Blandine; Cousin, Marie; Albarel, F.; Morange, Isabelle; Bruder, Nicolas; Brue, Thierry; Dufour, Henry

doi:10.1007/s11102-019-01004-3

Cited by 23 publications

(28 citation statements)

References 86 publications

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“…severe loss of vision or ophthalmoplegia) must be considered and performed at any time during pregnancy preferably in expert pituitary centres, including Pituitary Tumor Centers of Excellence/ Endo-ERN Reference Centers. The abovementioned statements are supported by the neurosurgical literature on meningioma management during pregnancy (223,227). R.2.8.…”

Section: Rationalementioning

confidence: 80%

“…In situations with chiasmal compression and severe loss of vision (impairment of visual acuity or OCT or severe visual field impairment) surgical decompression should be considered even if there is no detectable radiological enlargement of the tumour (191,223,224). Surgery provided symptom relief in 89.3% (95% CI: 71.8-97.7%), see 4.5 for details.…”

Section: Rationalementioning

confidence: 99%

“…The main indication for pituitary surgery during pregnancy is to protect visual function (191,223,224). A trial with cabergoline might be considered.…”

Section: Rationalementioning

confidence: 99%

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ESE Clinical Practice Guideline on functioning and nonfunctioning pituitary adenomas in pregnancy

Luger

Broersen

Biermasz

et al. 2021

European Journal of Endocrinology

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Pregnancies are rare in women with pituitary adenomas, which may relate to hormone excess from secretory subtypes such as prolactinomas or corticotroph adenomas. Decreased fertility may also result from pituitary hormone deficiencies due to compression of the gland by large tumours and/or surgical or radiation treatment of the lesion. Counselling premenopausal women with pituitary adenomas about their chance of conceiving spontaneously or with assisted reproductive technology, and the optimal pre-conception treatment, should start at the time of initial diagnosis. The normal physiological changes during pregnancy need to be considered when interpreting endocrine tests in women with pituitary adenomas. Dose adjustments in hormone substitution therapies may be needed across the trimesters. When medical therapy is used for pituitary hormone excess, consideration should be given to the known efficacy and safety data specific to pregnant women for each therapeutic option. In healthy women, pituitary gland size increases during pregnancy. Since some pituitary adenomas also enlarge during pregnancy, there is a risk of visual impairment, especially in women with macroadenomas or tumours near the optic chiasm. Pituitary apoplexy represents a rare acute complication of adenomas requiring surveillance, with surgical intervention needed in some cases. This guideline describes the choice and timing of diagnostic tests and treatments from the pre-conception stage until after delivery, taking into account adenoma size, location and endocrine activity. In most cases, pregnant women with pituitary adenomas should be managed by a multidisciplinary team in a centre specialised in the treatment of such tumours.

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Section: Rationalementioning

confidence: 80%

Section: Rationalementioning

confidence: 99%

See 1 more Smart Citation

ESE Clinical Practice Guideline on functioning and nonfunctioning pituitary adenomas in pregnancy

Luger

Broersen

Biermasz

et al. 2021

European Journal of Endocrinology

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“…If there is moderate visual field impairment, tight observation could be proposed until the delivery, and the surgical decision should be discussed postpartum. The decision in each case should be multidisciplinary, made on a case-by-case basis, and adapted to the delivery term [132,135].…”

Section: Pregnancy and Parasellar Meningiomasmentioning

confidence: 99%

Parasellar Meningiomas

Graillon¹,

Régis²,

Barlier³

et al. 2020

Neuroendocrinology

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Parasellar spaces remain particularly singular, comprising the most important neurovascular structures such as the internal carotid artery and optic, oculomotor, and trigeminal nerves. Meningiomas are one of the most frequent tumors arising from parasellar spaces. In this location, meningiomas remain mostly benign tumors with WHO grade I and a meningothelial subtype. Progestin intake should be investigated and leads mostly to conservative strategies. In the case of benign nonsymptomatic tumors, observation should be proposed. Tumor growth will lead to the proposition of surgery or radiosurgery. In the case of an uncertain diagnosis and an aggressive pattern, a precise diagnosis is required. For cavernous sinus and Meckel's cave lesions, complete removal is rarely considered, leading to the proposition of an endoscopic endonasal or transcranial biopsy. Optic nerve decompression could also be proposed via these approaches. A case-by-case discussion about the best approach is recommended. A transcranial approach remains necessary for tumor removal in most cases. Vascular injury could lead to severe complications. Cerebrospinal fluid leakage, meningitis, venous sacrifice, visual impairment, and cranial nerve palsies are more frequent complications. Pituitary dysfunctions are rare in preoperative assessment and in postoperative follow-up but should be assessed in the case of meningiomas located close to the pituitary axis. Long-term follow-up is required given the frequent incomplete tumor removal and the risk of delayed recurrence. Radiosurgery is relevant for small and well-limited meningiomas or intra-cavernous sinus postoperative residue, whereas radiation therapy and proton beam therapy are indicated for large, extended, nonoperable meningiomas. The place of the peptide receptor radionuclide therapy needs to be defined. Targeted therapy should be considered in rare, recurrent, and aggressive parasellar meningiomas.

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“…O procedimento ser evitado em casos de invasão da artéria carótida interna, quiasma óptico e seio cavernoso. Durante a gravidez também não deve ser adotado por aumentar a morbimortalidade materna e fetal (12,31) .…”

Section: Tratamentounclassified

Adenoma hipofisário secretor de TSH: uma revisão sistemática / TSH-secreting pituitary adenoma: a systematic review

Souza¹,

Morais

Morais³

et al. 2020

Arq Med Hosp Fac Cienc Med Santa Casa São Paulo

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Introdução: Os adenomas hipofisários são tumores caracterizados pela proliferação de células adeno-hipofisárias produtoras de hormônios tróficos. Dentre eles, os adenomas hipofisários produtores de TSH (TSHomas), neoplasias benignas pouco frequentes, que correspondem a menos do que 3% dos adenomas hipofisários. Método: Pesquisamos os termos TSHomas, tireotropinomas e adenomas pituitários secretores de TSH nas bases Pubmed, Lilacs e Scielo. Incluímos artigos publicados entre 2010 e 2020, sendo excluídos relatos de casos, artigos indisponíveis e que não tratavam sobre o tema. Resultados e discussão: Os TSHomas são tumores fibrosos, monoclonais, com incidência entre 0,015 a 0,03 casos/100.000 habitantes, que se manifestam por hipertireoidismo e sintomas causados por efeito de massa. São diagnosticados diante da elevação de TSH juntamente a hormônios tireoidianos, na presença de alterações neurorradiológicas. O tratamento de primeira escolha consiste na neurocirurgia transesfenoidal, sendo os análogos de somatostatina e a radioterapia alternativas para o manejo de pacientes em que a intervenção cirúrgica é desaconselhada. Conclusão: Os TSHomas são raros, contudo, precisam ser investigados diante da secreção inadequada de TSH.Palavras chave: Adenoma, Hormônios tireoidianos, Neoplasias hipofisárias, Síndrome da secreção inadequada de TSH, Hipertireoidismo centralABSTRACTIntroduction: Pituitary adenomas are tumors characterized by the proliferation of adenohypophysis cells that produce trophic hormones. Among them, TSH-producing pituitary adenomas (TSHomas), uncommon benign neoplasms, whichcorrespond to less than 3% of pituitary adenomas. Method: We searched for the terms TSHomas, thyrotropinomas and pituitary adenomas secreting TSH in the Pubmed, Lilacs and Scielo databases. We included articles published between 2010 and 2020, excluding case reports, articles that were unavailable and did not deal with the topic. Results and discussion: TSHomas are fibrous, monoclonal tumors, with an incidence of 0.015 to 0.03 cases / 100,000 inhabitants, which are manifested by hyperthyroidism and symptoms caused by a mass effect. They are diagnosed with elevated TSH along with thyroid hormones, in the presence of neuroradiological changes. The first-choice treatment consists of transsphenoidal neurosurgery, with somatostatin analogs and radiotherapy being alternatives for the management of patients in whom surgical intervention is not recommended. Conclusion: TSHomas are rare, however, they need to be investigated due to inadequate TSH secretion.Keywords: Adenoma, Thyroid hormones, Pituitary neoplasms, Inappropriate TSH secretion syndrome, Central hypothyroidism

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Surgical indications for pituitary tumors during pregnancy: a literature review

Cited by 23 publications

References 86 publications

ESE Clinical Practice Guideline on functioning and nonfunctioning pituitary adenomas in pregnancy

ESE Clinical Practice Guideline on functioning and nonfunctioning pituitary adenomas in pregnancy

Parasellar Meningiomas

Adenoma hipofisário secretor de TSH: uma revisão sistemática / TSH-secreting pituitary adenoma: a systematic review

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