Endocrine Abstracts

Introduction: Pituitary tumours may interfere with fertility and pregnancy may be uncommon in these cases, but some patients can conceive spontaneous. Also in pregnancy, due to the physiologic changes of the pituitary gland, gradual volume increase and cellular hyperplasia that target hormonal secretion, the evaluation of the pituitary function is very complex.

Clinical cases: We present 5 cases of female patients (24 – 35 years old) that were diagnosed with different pituitary tumours and conceived. 2 patients were with acromegaly, 1 of them with macroprolactinoma, 1 with with microprolactinoma and the last one with non-functional pituitary adenoma. All women conceived naturally. We report 6 pregnancies with a positive outcome out of a total of 9. The patients with acromegaly had macroadenomas, one of them had conceived before the biochemical diagnosis of acromegaly. The other patient had gonadotroph deficiency after transsphenoidal surgery and gamma-knife radiosurgery and substitutive therapy. She had a spontaneous pregnancy during the estroprogestative treatment. She had a decrease in IGF-1 during pregnancy which after pregnancy returned to pathological elevated values. The patient diagnosed with microprolactinoma had an early pregnancy failure before her diagnostic was established. The patient conceived (twin pregnancy) under treatment with dopamine agonist her disease was controlled, and it was stopped immediately after the confirmation of the pregnancy. Unfortunately due to major cardiac malformations of the foetuses pregnancy interruption was indicated. The patient with macroprolactinoma had conceived many years prior the diagnostic. After thediagnostic of macroprolactinoma she conceived under treatment with bromocriptine. The gynaecologist indicated pregnancy interruption. Due to the resistance under high doses of dopamine agonists the patient underwent 5 cycles of temolozolomide with good outcomes. She conceived again and the pregnancy outcome was good. The last patient from our series had a non-functional pituitary microadenoma and successfully conceived after several years of attempts. During pregnancy the hormonal profile showed elevated IGF-1 (2 × upper normal limit), and GH slightly elevated, most likely due to the physiological changes in pregnancy. The pregnancy outcome was positive. During pregnancy hormonal follow-up was made using IGF-1, GH (assay with no distinction of pituitary GH versus placental GH, PRL (prolactin), visual field and pituitary imaging was performed after delivery.

Conclusions: Managing pituitary dysfunctions in pregnancy can be challenging. The indications are to stop any medications that control prolactin or GH hypersecretion during pregnancy. Patients with different pituitary disorders can have successful pregnancies, even in patients with uncontrolled hypersecretion.