Hormonally Active Pituitary Adenomas and Pregnancy: A Systematic Review

Hormonally active pituitary adenomas are rare endocrine tumors that can affect hormonal balance and pregnancy outcomes. This study aims to assess hormonally active pituitary adenomas among pregnant women, considering worldwide studies that assess their tumor types, responses to treatment practices, their treatment patterns, their effectiveness, and pregnancy complications.

A systematic review of 11 global studies published between 2019 and 2024. Data were retrieved from Web of Science, Scopus, PubMed, CORE, and Google Scholar databases, employing MeSH keywords. Boolean operators were employed to refine the results.

The findings reveal that the sample sizes range from 20 to 107 participants, with the largest sample in Pakistan (107 participants) and the smallest in India (20 participants). Tumor categories include mixed tumors (45%), macroadenomas (27%), microadenomas (10%), and unspecified tumor types (18%). The main treatment was the administration of dopamine agonists, which were typically stopped upon pregnancy confirmation, with exceptions in two cases. Treatment was restarted or adjusted to control tumor progression or initiated after the first trimester to minimize fetal risks. In 28 pregnancies, dopamine agonists were discontinued, but continued in six pregnancies due to insufficient tumor reduction. Surgical treatments were generally performed in the second trimester, with conservative management for stable cases.

Dopamine agonists, surgery, and multidisciplinary approach are frequently highlighted in the research on pituitary adenomas and hyperprolactinemia.