ESE Clinical Practice Guideline on functioning and nonfunctioning pituitary adenomas in pregnancy

Area of Science:

• Endocrinology
• Reproductive Medicine
• Neurosurgery

Background:

• Pituitary adenomas can impair fertility through hormone excess or deficiency.
• Large tumors can cause hypopituitarism via compression, impacting reproductive function.
• Secretory adenomas like prolactinomas and corticotroph adenomas are associated with rare pregnancies.

Purpose of the Study:

• To provide guidance on managing pregnancies in women with pituitary adenomas.
• To outline diagnostic and treatment strategies from preconception to postpartum.
• To address the unique physiological changes and risks during pregnancy.

Main Methods:

• Review of existing literature and clinical guidelines.
• Consideration of adenoma characteristics (size, location, endocrine activity).
• Emphasis on multidisciplinary team management and specialized centers.

Main Results:

• Pregnancy management requires careful monitoring of hormonal status and tumor behavior.
• Physiological changes in pregnancy necessitate adjustments to hormone replacement and medical therapies.
• Pituitary adenomas may enlarge during pregnancy, increasing risks like visual impairment and pituitary apoplexy.

Conclusions:

• Early preconception counseling is crucial for women with pituitary adenomas.
• Management requires a tailored approach considering individual tumor and patient factors.
• Multidisciplinary care in specialized centers ensures optimal outcomes for pregnant women with pituitary adenomas.