[Pituitary disorders in pregnancy]

During pregnancy there is a normal increase in the volume of the anterior pituitary as demonstrated by MRI and hormone secretions which increase (PRL) or decrease (FSH, LH). During pregnancy pituitary adenomas, especially prolactinomas, may evolve as in non-pregnant women (microadenomas) or differently (macroadenomas). In 35 % of cases macroprolactinomas worsen during pregnancy making their medico-surgical management mandatory prior to pregnancy. Inversely, pregnancy occurring in a subject with a microprolactinoma never induces severe local complications so such tumors may be managed surgically or medically. Surgery should be performed for acromegaly or Cushing's disease before or early in pregnancy. Subacute pituitary apoplexy (intratumoral hemorrhage) occurs in about 10 to 15 % of adenomas but, generally speaking, clinical symptoms remain mild in pregnant women. Lymphocytic hypophysitis occurs at the end of pregnancy, or during the post-partum period. The association of complete pan-hypopituitarism and hypersignal on MRI examination may mimic hypophyseal apoplexy and could lead to and inappropriate surgical procedure.