The Incidence of Complications During Pregnancy after Treatment of Hyperprolactinemia with Bromocriptine in Patients with Radiologically Evident Pituitary Tumors

Lamberts, Steven W. J.; Klijn, Jan G.M.; Lange, S. A. de; Singh, R. B.; Stefanko, S. Z.; Birkenhäger, J. C.

doi:10.1016/s0015-0282(16)44050-1

Cited by 60 publications

(8 citation statements)

References 6 publications

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“…We included 28 studies on transsphenoidal surgery of pituitary adenomas during pregnancy (28,49,124,135,153,157,168,169,170,171,172,173,174,175,176,177,178,179,180,181,182,183,184,185,186,187,188,189), see Appendix 5 Table 1 for the GRADE evidence, and Appendix 5 Table 2 for study details. Pituitary surgery was performed in 33 cases during pregnancy.…”

Section: Clinical Question V: Is Pituitary Surgery Safe For Pituitary Adenomas During Pregnancy?mentioning

confidence: 99%

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: Clinical Question V: Is Pituitary Surgery Safe For Pituitary Adenomas During Pregnancy?mentioning

confidence: 99%

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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“…However, all procedures are not an absolute guarantee for an uncomplicated pregnancy (Lamberts et al 1979;Thorner et al 1975) and have their own complication rate (Fahlbusch et al 1978; Harris & Levene 1976;Joplinetal. 1975).…”

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confidence: 99%

Influence of pregnancies on prolactinomas

Rjosk

Fahlbusch²,

Werder

1982

Acta Endocrinologica

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Hyperprolactinaemic patients desiring pregnancy with a normal sella turcica or radiological evidence for a microprolactinoma without suprasellar extension were treated with bromocriptine. Females desiring pregnancy with large adenomas or suprasellar extension were treated by transsphenoidal surgery and in most instances post-operatively with bromocriptine. This differentiated management allowed the outcome of 65 pregnancies with delivery at term without complications related to the sella turcica.Considerable variations of prolactin levels during pregnancy suggesting different oestrogen sensitivity of the prolactinoma cells were encountered. However, a rapid fall of the prolactin levels in 60 patients after termination of pregnancy indicated that oestrogen stimulation does not cause persisting growth of the adenoma. In contrast, in 10% of pregnancies of hyperprolactinaemic patients a reduction of the prolactin levels has been observed leading to spontaneous ovulatory cycles in 5 patients.The optimal management of sterility of hyper¬ prolactinaemic females, particularly of patients with radiological evidence for a prolactinoma, is still controversial. During normal pregnancy the volume of the pituitary gland increases by approxi¬ mately 70% (Erdheim & Stumme 1909). If lactotrophic tissue is already increased before preg¬ nancy, a dramatic enlargement of the pituitary gland with suprasellar extension, headaches, and compression of the chiasma opticum may occur.In addition to the acute complications during pregnancy persisting enlargement of the prolac¬ tinoma due to excessive oestrogen stimulation of the lactotrophic adenoma cell cannot be excluded.In order to prevent these complications several procedures have been recommended before induc¬ tion of ovulation in hyperprolactinaemic patients:Radiotherapy of the pituitary gland (Besser et al. 1977), implantation of 90Yttrium (Child et al. 1975), or transsphenoidal surgery in every patient (Hardy et al. 1978). However, all procedures are not an absolute guarantee for an uncomplicated pregnancy (Lamberts et al. 1979; Thorner et al. 1975) and have their own complication rate (Fahlbusch et al. 1978; Harris & Levene 1976; Joplinetal. 1975).In the following study prolactin was monitored as a marker for adenoma growth in differentially treated hyperprolactinaemic females during and after pregnancy. The aim of this study was to investigate the impact of pregnancy on the devel¬ opment of hyperprolactinaemia and the prolactin¬ oma in a large group of patients which should contribute to solve some of the questions concern¬ ing the management of female hyperprolactinae¬ mic sterility. Materials and MethodsSixty-one patients with hyperprolactinaemia of intrasellar origin were studied. In these patients altogether 81 pregnancies were observed, of which 65 were completed with delivery at term. In addition one pregnancy after operative treatment of a chronic hydrocephalus internus has been followed up.

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“…MAD 16 þ þ þ Scherrer et al 28 ? mAD 28 þ þ þ Lunardi et al 29 21 (multi) -24 þ þ þ Fujimaki et al 30 23 (G1) -24 þ þ Ginath et al 31 31 (G1) PRL 39 þ þ þ Heide et al 32 26 (multi) -23 þ þ þ Janssen et al 33 27 (G1) -10 þ þ þ þ Bamfo et al 34 31 (G1) -10 þ þ þ Lee et al 35 26 (G1) -24 þ þ þ þ Lamberts et al 36 30 (G1) PRL 23 þ þ þ þ Rosen et al 37 32…”

Section: Discussionmentioning

confidence: 99%

Pituitary apoplexy in pregnancy: A case series and literature review

et al. 2015

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Background: Severe headache during pregnancy is a challenging condition that may rarely imply endocrine disturbances. Rapid recognition of pituitary apoplexy is needed to improve pregnancy outcome.Objective: To review and compare maternal and fetal outcomes after pituitary apoplexy. Methods: Four cases of pituitary apoplexy during pregnancy in our centre are reported and literature review covering the past 54 years was performed.Results: In the four cases presented and the 33 reported in the literature, most women presented with severe headaches and systemic symptoms.Overall, 42% were treated surgically, 31% received bromocriptine or cabergoline and 61% were given hormone replacement. No major obstetrical complication was reported and all babies were healthy. Conclusion:Pituitary apoplexy is a rare cause of sudden and severe headache during pregnancy. Rapid identification of this condition with potentially associated endocrine disturbances is important to ensure maternal and fetal well-being. A multidisciplinary team approach seems to reduce morbidity and mortality.

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The Incidence of Complications During Pregnancy after Treatment of Hyperprolactinemia with Bromocriptine in Patients with Radiologically Evident Pituitary Tumors

Cited by 60 publications

References 6 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

Influence of pregnancies on prolactinomas

Pituitary apoplexy in pregnancy: A case series and literature review

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