Visual Loss in Pregnant Women with Pituitary Adenomas

Kupersmith, Mark J.; Rosenberg, Carl; Kleinberg, David L.

doi:10.7326/0003-4819-121-7-199410010-00001

Cited by 130 publications

(53 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nessa situação, instituise o tratamento com a bromocriptina. Raramente é necessária a remoção do prolactimoma pela via transesfenoidal durante a gravidez 18,19,21 . Segundo Molitch 20 , nem a cirurgia nem o tratamento clínico são indicados nos casos de adenomas secretores do hormônio do crescimento e nos adenomas não funcionantes, entretanto, no caso de adenomas secretores do hormônio adenocorticotropico, a cirurgia é indicada durante a gravidez, com o objetivo de reduzir a perda fetal e controlar o hipertiroidismo.…”

Section: Discussionunclassified

Tumor cerebral e gravidez

Lynch

Emmerich

Kislanov

et al. 2007

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

RESUMO -O diagnóstico de um tumor cerebral durante a gravidez é um fato raro que coloca a mãe e o concepto em risco de vida. Objetivo: Avaliar a melhor forma de conduzir uma paciente grávida portadora de um tumor cerebral. Método: Realizamos análise retrospectiva dos prontuários e imagens de seis pacientes grávidas portadoras de tumor cerebral. Resultados: Vários tipos histológicos de tumor cerebral podem estar associados à gravidez. O meningioma é o mais freqüente. Nessa série não observamos óbito cirúrgi-co materno. Em duas pacientes, o parto ocorreu antes da craniotomia e em outras quatro o parto foi realizado após a neurocirurgia. Conclusão: O momento mais adequado para a realização da craniotomia para remoção tumoral irá depender da gravidade do quadro neurológico, do tipo histológico presumível da lesão, e da idade gestacional do embrião. PALAVRAS-CHAVE: gravidez, tumor cerebral, meningioma, microneurocirurgia. Brain tumors and pregnancyABSTRACT -Background: Despite not being a common fact, the occurrence of brain tumors during pregnancy poses a risk to both the mother and infant. Aim: To identify the best medical procedure to be followed for a pregnant patient harboring a brain tumor. Method: The records of 6 patients with brain tumors, diagnosed during pregnancy were examined. Results: Several types of brain tumors have been associated with pregnancy, but the meningioma is, by far, the most frequent. It seems that pregnancy aggravates the clinical course of intracranial tumors. There were no operative mortality in these series. In 2 patients the labor occurred before the craniotomy and in others, the delivery occurred after the surgery. Conclusion: The best moment to recommend the craniotomy and the neurosurgical removal of the tumor will depend of the mother's neurological condition, the tumor histological type as well as the gestational age. RJ -Brasil. E-mail: cneuroamericas@uol.com.br O diagnóstico de um tumor cerebral durante a gravidez é um evento extremamente raro [1][2][3][4][5][6][7][8][9][10][11] . Dr. José Carlos Lynch -Rua Jardim Botânico 600 / 605 -22461-000 Rio de JaneiroO surgimento de um tumor cerebral durante uma gestação coloca a mãe e concepto em risco de vida 4,7,10,11 , e também suscita dilemas de ordem neurocirúrgica, clínica, obstétrica, ética e psicológica. A utilização de uma abordagem multidisciplinar para essas pacientes é fundamental porque se está lidando com pacientes que se encontram em um momento crítico de suas vidas, quando ocorrem profundas mudanças orgânicas e psíquicas.Analisamos seis casos de nossa experiência. MÉTODOEntre os anos de 1996 e 2005, 6 mulheres que se encontravam no período gestacional e com o diagnóstico de tumor cerebral foram tratadas no Serviço de Neurocirurgia do Hospital dos Servidores do Estado (HSE), no Rio de Janeiro.As pacientes também foram acompanhadas pelos serviços de obstetrícia, psicologia e anestesia que discutiram entre si e determinaram, juntamente com as famílias e as pacientes, as condutas que foram instituídas. Todos os pós-oper...

show abstract

Section: Discussionunclassified

Tumor cerebral e gravidez

Lynch

Emmerich

Kislanov

et al. 2007

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

show abstract

“…Most commonly however, it is disruption to the hypothalamic-pituitary-ovarian axis following pituitary surgery and or radiotherapy that leads to sub-fertility. Pregnancy in patients with acromegaly has been reported after surgical intervention alone [3] and following treatment with bromocriptine [4], octreotide and lanreotide. Although the number of cases is small, no adverse effects on fetal development have been documented with use of these pharmaceutical agents.…”

Section: Discussionmentioning

confidence: 99%

IVF/ICSI in a woman with active acromegaly: Successful outcome following treatment with pegvisomant

Qureshi

Kalu

Ramanathan

et al. 2006

J Assist Reprod Genet

View full text Add to dashboard Cite

A 29 year old woman with difficult to control acromegaly and a pituitary macroadenoma responded to pegvisomant therapy and subsequently conceived with her first cycle of in-vitro fertilization and intra-cytoplasmic sperm injection. Pregnancy was complicated by gestational diabetes, pituitary gland enlargement and deteriorating visual fields. Conservative management with elective cesarean section was performed at 32 weeks gestation. A healthy boy was delivered who remains developmentally normal at 1 year. This complex case required intricate care by a multidisciplinary team and is likely to represent the first in many cases of assisted conception on pegvisomant therapy for active acromegaly. Keywords Case reportA 29 year old Caucasian woman was diagnosed with acromegaly following a two year history of secondary amenorrhea, change in physical appearance and sweating. The diagnosis was confirmed with an oral glucose tolerance test and radiological imaging that demonstrated a 2.2 cm pituitary tumor compressing the optic chiasm. A bi-temporal visual field defect was confirmed using binocular Goldman perimetry.Over a four-year period, she underwent four transphenoidal hypophysectomies and received 53 Gy radiotherapy. Despite a reduction in tumor size (Fig. 1) and the use of somatostatin analogues, she failed to achieve biochemical cure and her insulin-like growth factor-I (IGF-I) level remained persistently high (96-120 nmol/L; normal range 16-52 nmol/L). Hydrocortisone and thyroxine replacement was required for pituitary deficiency.She was desperate to conceive and was counseled on the effect of pregnancy on acromegaly and the risks of pituitary tumor enlargement. After failing to conceive with clomifene therapy she was referred to the assisted conception unit. Her husband was discovered to be oligoasthenozoospermic and they were counseled for in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).To achieve control of her acromegaly, she was started on daily subcutaneous injections of 20 mg pegvisomant, a highly selective growth hormone receptor (GHR) antagonist, and octreotide was discontinued. Her IGF-I subsequently normalized for the first time in 5 years.Pituitary down regulation was achieved with a GnRH analogue and she required four days of 300 IU recombinant FSH which was increased to 450 IU on day five of stimulation for a further 11 days for super-ovulation. She produced a total of 14 follicles and transvaginal ultrasound-guided oocyte Springer

show abstract

“…Sometimes apoplexy of pituitary adenoma with visual field loss may be the first sign during pregnancy (172). The risk of visual field defect is increased in patients whose tumor is more than 1.2 cm in size (143). Increased pituitary gland size due to lactotroph hyperplasia may contribute to the mass effect of pituitary adenomas during pregnancy with a rapid response to bromocriptine (173).…”

Section: Nonfunctioning Pituitary Adenomas and Pregnancymentioning

confidence: 99%

“…The second option may be preferred when the duration of dopamine agonist therapy before conception is short or when the tumor is outside intrasellar boundaries. If clinical signs of progression such as severe headache and visual field defects occur, an MRI without Gd should be performed, and then a dopamine agonist should be restarted if there is an increase in tumor size (143). If there is no response to dopamine agonist therapy, delivery may be the treatment of choice when the term is close.…”

Section: Prolactinomas and Pregnancymentioning

confidence: 99%

Pregnancy and pituitary disorders

Karaca¹,

Tanrıverdi²,

Ünlühızarcı³

et al. 2010

European Journal of Endocrinology

156

View full text Add to dashboard Cite

Major hormonal changes emerge during pregnancy. The pituitary gland is one of the most affected organs with altered anatomy and physiology. The pituitary gland is enlarged as a result of lactotroph hyperplasia. Due to physiological changes in the pituitary and target hormone levels, binding globulins, and placental hormones, hormonal evaluation becomes more complex in pregnant women. As a consequence of physiological hormonal changes, the evaluation of pituitary functions in pregnant women is quite different from that done in the prepregnant state. Pituitary adenomas may cause problems by their hormone secretion that affects the mother and the fetus besides causing an increased risk of tumor growth. Furthermore, diagnosis, course, and treatment of pituitary diseases point out differences. The changes in anatomy and physiology of the pituitary gland during pregnancy are reviewed. Pituitary disorders namely Cushing's disease; acromegaly; prolactinoma; TSH-secreting, gonadotropin-producing, and clinically nonfunctioning adenomas; craniopharyngioma; and Sheehan's syndrome, which is one of the most common causes of hypopituitarism, lymphocytic hypophysitis, and hypopituitarism, in relation to pregnancy are discussed. Being aware of all this information will prevent any serious problems which mother and child will be exposed to.

show abstract

Visual Loss in Pregnant Women with Pituitary Adenomas

Abstract: The risk for developing visual loss during single or multiple pregnancies in patients with microadenomas was small. Six of eight pregnant women with macroadenomas, however, developed visual field loss during pregnancy.

Cited by 130 publications

References 0 publications

Tumor cerebral e gravidez

Tumor cerebral e gravidez

IVF/ICSI in a woman with active acromegaly: Successful outcome following treatment with pegvisomant

Pregnancy and pituitary disorders

Contact Info

Product

Resources

About