Thyrotropin-secreting pituitary adenomas in pregnancy: insights from a systematic review

Thyrotropin-secreting pituitary adenomas (TSHomas) are rare neuroendocrine tumors that account for less than 1% of all pituitary adenomas. Managing TSHomas during pregnancy presents a unique challenge, balancing physiological thyroid changes with risks of tumor progression and maternal-fetal complications. This systematic review analyzes reported cases of TSHomas diagnosed before and during pregnancy, focusing on clinical presentation, diagnostic difficulties, treatment, and maternal-fetal outcomes. A systematic literature search in the PubMed, Scopus, and Cochrane Library databases identified nine case reports of pregnant patients with TSHomas between 1993 and 2024. Common symptoms included hyperthyroidism-related manifestations (55%), galactorrhea (33%), and anxiety (44%). Diagnostic challenges arose from pregnancy-related thyroid changes requiring careful interpretation of trimester-specific thyroid function tests and imaging findings. Management strategies included somatostatin analogs (SSAs), antithyroid drugs, and transsphenoidal surgery (TSS). SSAs were discontinued during pregnancy but resumed in select cases due to tumor progression. Surgery was generally deferred until postpartum unless significant mass effects warranted urgent intervention. TSS was performed in one case during pregnancy due to mass effect symptoms. All pregnancies resulted in live births except one elective termination. No severe maternal or fetal complications were reported. The findings emphasize the importance of a multidisciplinary approach in managing TSHomas during pregnancy. Early recognition, tailored medical therapy, and close endocrine-obstetric collaboration are crucial to optimize outcomes. Differentiation from resistance to thyroid hormone (RTH) is critical for accurate diagnosis. While SSAs and delayed surgical intervention appear safe and effective, further research is required to refine diagnostic and therapeutic protocols and to investigate the molecular pathogenesis of this rare condition.