Management of pituitary tumors in pregnancy

Abstract

Pituitary tumors, usually adenomas, account for about 10-15% of all intracranial tumors. Their treatment, which includes surgery, medicine or radiotherapy, either isolated or in combination, aims to halt tumor growth or achieve tumor shrinkage, as well as control hormone hypersecretion or ensure hormone replacement. Such approaches have made pregnancy possible for women with pituitary adenomas. Medical therapy with dopamine agonists is the treatment of choice for most patients with prolactinomas, with surgery reserved for individuals resistant to drugs. On the other hand, surgery before conception is indicated as a first-line approach in patients with acromegaly, Cushing disease or clinically nonfunctioning pituitary macroadenomas. In these patient populations, medical therapy with somatostatin analogues (acromegaly) or drugs that target the adrenal glands, such as metyrapone and ketoconazole (Cushing disease), should be reserved for those in whom surgery is unsuccessful or contraindicated.

MANAGEMENT OF ENDOCRINE DISEASE: Acromegaly and pregnancy: a contemporary review

“…By the end of pregnancy, average GH-V levels are 13-25 µg/L, depending on assay, with a wide range from <10 to 60 µg/L (19,20). IGF-1 levels are, in average, nearly two-fold higher than pre-pregnancy levels and also show large interindividual variability (39,40). Such increment in IGF-1 levels results from the interaction between the stimulatory effect of the high and sustained concentrations of GH-V in late pregnancy, comparable to the concentrations of GH-N found in active acromegaly, and the relative peripheral resistance (mostly or exclusively at the liver) to GH induced by high estrogen concentrations (31,32).…”

MANAGEMENT OF ENDOCRINE DISEASE: Management of pregnant patients with Cushing's syndrome

“…Similarly to non-pregnant women, surgery is usually the first treatment option in pregnant CS patients (1,17,23,24). On the other hand, further options to treat hypercortisolism, such as radiotherapy and mitotane, are contraindicated in this period because of their potential harmful or teratogenic effects and their delayed outcomes (25).…”

“…Surgical treatment was performed on ACTH-secreting pituitary adenomas between the end of the first trimester and the early second trimester (12-29 weeks gestation), a period associated with a lower rate of maternal and fetal complications. Several factors can influence the decision to perform surgery, including the etiology, severity, stage of gestation, and therapeutic riskbenefit for the maternal-fetal outcomes (24).…”

Growth of an aggressive tumor during pregnancy in an acromegalic patient

“…Limited data is available about pregnancy in acromegaly [4,10]. In relation to hormonal hypersecretion, it is known that in normal pregnancy occurs secretion of placental GH variant, whose levels increase progres- A B…”