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

Abstract

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.

Italian Association of Clinical Endocrinologists (AME) and International Chapter of Clinical Endocrinology (ICCE). Position statement for clinical practice: prolactin-secreting tumors

“…Close clinical monitoring should be undertaken with formal visual field testing during each trimester ( 197 ). The continuation or reinstitution of therapy should be considered in the case of large pituitary tumors particularly if the adenoma is in close vicinity to the optic chiasm or signs of tumor expansion develop during pregnancy ( 197 , 198 , 202 ). Due to its higher efficacy and better tolerability, Cab is preferable in these cases ( 202 ).…”

“…Although limited, surgical risks remain difficult to assess ( 205 ). In the third trimester, preterm delivery should be considered ( 202 ).…”

“…The number of pregnancies per woman as well as breastfeeding and its duration did not influence remission rate ( 198 , 208 , 212 ). In case of remission, clinical and hormonal follow-up at 6 months after delivery and yearly thereafter has been recommended ( 202 ).…”

Update in Pathogenesis, Diagnosis, and Therapy of Prolactinoma

“…Prolactinomas in young women often coincide with pregnancy and childbirth, and thus careful management is required. Although bromocriptine and cabergoline have been shown to have no adverse effects on the course of the pregnancy or the fetus, DAs should be discontinued in principle if pregnancy occurs during drug therapy [ 63 , 64 ]. There were no abnormalities in maternal–fetal outcomes in 6272 pregnancies with bromocriptine or in 1061 with cabergoline [ 65 ].…”

“…An MRI scan without gadolinium should be performed if a patient with macroprolactinoma has severe headaches or a visual field defect. DAs or transsphenoidal surgery should be considered if aggressive macroprolactinoma is evident [ 63 , 64 ].…”