Management of pituitary tumors in pregnancy

Successful pregnancy and delivery is dependent upon normal function of the pituitary gland. Benign tumors of the pituitary are relatively common and may interfere with normal pregnancy in a variety of ways. Symptoms related to pituitary tumors can include headache, fatigue, and visual loss. Some may present dramatically with pituitary tumor apoplexy, mimicking subarachnoid hemorrhage, meningitis, or myocardial infarction. In this article, the types of tumors likely to become symptomatic during pregnancy are reviewed. The various options of management are determined by the stage of pregnancy and whether there is visual loss or other signs of mass effect. Management options include close observation, medical therapy, or surgical removal of the tumor. Decision making for symptomatic adenomas during pregnancy is illustrated by two representative case reports.