Evaluation and management of pituitary tumors during pregnancy

To review the recommended management of pituitary tumors that occur in pregnant patients.

Studies from the literature and personal experience are summarized, and guidelines for optimal maternal and fetal outcome are suggested.

Tumors are the most common pituitary disorder affecting pregnant patients. Hyperprolactinemia must be corrected to allow ovulation and fertility. Bromocriptine has been shown to be safe for use during early gestation. Patients have less than a 2% risk of microprolactinoma enlargement during pregnancy but approximately a 16% risk of symptomatic enlargement of a macroprolactinoma. Treatment options for patients with macroadenomas include discontinuing bromocriptine therapy when pregnancy is confirmed and reinstituting this treatment if the tumor enlarges; continuous bromocriptine therapy throughout the pregnancy; and prepregnancy surgical debulking of the tumor. The diagnoses of acromegaly and Cushing's disease are difficult to make during pregnancy. The hormone oversecretion in these conditions may exacerbate tendencies to gestational diabetes, fluid retention, and hypertension. Cushing's syndrome should be treated during pregnancy, but treatment for acromegaly and other tumors may be deferred. Rare reports have described enlargement of clinically nonfunctioning and growth hormone-secreting tumors during pregnancy, and surveillance is needed. Tumors may need to be distinguished from lymphocytic hypophysitis.

Physicians should be aware of the normal pituitary changes during pregnancy and the major clinical and laboratory findings associated with pituitary tumors for optimal management of pregnant patients.