Endocrine Abstracts

Introduction: Pregnancy results in a significant change in pituitary gland size and function.

Due to this physiological adaptation, management of pituitary adenomas during pregnancy represents a particularly complex challenge. Aim of this study was to focus on a single referral institution experience with special attention to this subgroup of patients: pregnant woman affected by pituitary adenoma.

Materials and methods: This is a descriptive observational study, all patients with macroadenoma and who had at least one pregnancy were included. We studied 10 women who got pregnant during their endocrinological follow-up. They were divided as follows: 4 GH and PRL secreting tumors, 2 Cushing diseases, 2 acromegaly, 1 PRL secreting tumor and 1 non functioning macroadenoma. In order to describe the outcome of the adenoma during pregnancy, we considered the previous surgical and medical therapy, hormonal serum levels, imaging data and medical therapy during and after pregnancy. We also analyzed the obstetrical outcomes of their pregnancies.

Results: The median age of the patients was 35. They all had a previous transphenoidal surgery of the pitutitary adenoma. The two patients affected by Cushing disease also had bilateral surrenectomy, due to lack of disease control and due to hyposurrenalism undergone therapy with hydrocortisone. After surgery, because of residual disease, a patient affected by GH and PRL secreting tumors, one affected by acromegaly and the patient affected by non functioning macroadenoma were treated with somatostatin analogs and the other one affected by acromegaly started dopamine agonists. When the patients showed desire for pregnancy, medical therapy was discontinued evaluating hormonal tests and MR imaging. The residual disease at MRI was stable during and after pregnancy and did not affect the optic chiasma, without visual field alterations or reduced vision.

Obstetrical outcomes showed no malformation, one twin pregnancy, two caesarean-sections. The patients already undergoing medical treatment before pregnancy, restarted it after pregnancy.

Conclusions: Studies on pituitary adenoma management during pregnancy are limited. In our study, no complication was reported in patients with or without residual tumour on the preconception MRI, regardless of the initial size and of the discontinuation of medical therapy. Patients did not need any kind of therapy during pregnancy and did not show any symptomatic progression of adenomas, without ophthalmological abnormalities or apoplexy. Because of the potential risk that these conditions represents for the mother and the fetus, it is essential to keep patients under close follow-up and treat them quickly and successfully.