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

European Journal of Endocrinology, vol. 185, pp. G1–G33

Abstract

Pregnancies are rare in women with pituitary adenomas, which may relate to hormone excess from secretory subtypes such as prolactinomas or corticotroph adenomas. Decreased fertility may also result from pituitary hormone deficiencies due to compression of the gland by large tumours and/or surgical or radiation treatment of the lesion. Counselling premenopausal women with pituitary adenomas about their chance of conceiving spontaneously or with assisted reproductive technology, and the optimal pre-conception treatment, should start at the time of initial diagnosis. The normal physiological changes during pregnancy need to be considered when interpreting endocrine tests in women with pituitary adenomas. Dose adjustments in hormone substitution therapies may be needed across the trimesters. When medical therapy is used for pituitary hormone excess, consideration should be given to the known efficacy and safety data specific to pregnant women for each therapeutic option. In healthy women, pituitary gland size increases during pregnancy. Since some pituitary adenomas also enlarge during pregnancy, there is a risk of visual impairment, especially in women with macroadenomas or tumours near the optic chiasm. Pituitary apoplexy represents a rare acute complication of adenomas requiring surveillance, with surgical intervention needed in some cases. This guideline describes the choice and timing of diagnostic tests and treatments from the pre-conception stage until after delivery, taking into account adenoma size, location and endocrine activity. In most cases, pregnant women with pituitary adenomas should be managed by a multidisciplinary team in a centre specialised in the treatment of such tumours.

Authors 15

1. A Luger corresponding

   Medical University of Vienna

   Affiliation as printed

   1Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria

2. Leonie H. A. Broersen Aachen 2Division of Endocrinology Department of Medicine, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   2Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands

3. Nienke Ruurdje Biermasz Aachen 3Division of Endocrinology Department of Medicine Pituitary Center and Center for Endocrine Tumors

   Leiden University Medical Center

   Affiliation as printed

   3Division of Endocrinology, Department of Medicine, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands

4. Beverly M. K. Biller

   Harvard University · Massachusetts General Hospital

   Affiliation as printed

   4Neuroendocrine & Pituitary Tumor Clinical Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

5. Michael Buchfelder

   Universitätsklinikum Erlangen

   Affiliation as printed

   5Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany

6. Philippe Chanson

   Inserm · Université Paris-Saclay · Assistance Publique – Hôpitaux de Paris · Bicêtre Hospital · Physiologie et Physiopathlogie Endocriniennes

   Affiliation as printed

   6Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction et Centre de Réference des Maladies Rares de l’Hypophyse, Le Kremlin-Bicêtre, France

7. Jens Otto Lunde Jørgensen

   Aarhus University Hospital

   Affiliation as printed

   7Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark

8. Fahrettin Keleştimur

   Yeditepe University

   Affiliation as printed

   8Department of Endocrinology, Yeditepe University, Istanbul, Turkey

9. Sofia Llahana

   University of London · City, University of London

   Affiliation as printed

   9School of Health Sciences, City, University of London, London, UK

10. Dominique M. Maiter

    Cliniques Universitaires Saint-Luc · UCLouvain

    Affiliation as printed

    10Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

11. Gesthimani Mintziori

    Aristotle University of Thessaloniki

    Affiliation as printed

    11Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece

12. Felice Petraglia

    University of Florence

    Affiliation as printed

    12Department of Obstetrics and Gynecology, University of Florence, Florence, Italy

13. Rasa Verkauskienė

    Lithuanian University of Health Sciences

    Affiliation as printed

    13Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania

14. Susan M. Webb

    Universitat Autònoma de Barcelona · Instituto de Salud Carlos III · Hospital de Sant Pau · Centre for Biomedical Network Research on Rare Diseases

    Affiliation as printed

    14IIB-Sant Pau and Department of Endocrinology/Medicine, Hospital Sant Pau, Universitat Autónoma de Barcelona, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unit 747), ISCIII, Barcelona, Spain

15. Olaf M. Dekkers Aachen 15Department of Clinical Epidemiology 16Department of Clinical Endocrinology

    Aarhus University · Leiden University Medical Center

    Affiliation as printed

    15Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands

    16Department of Clinical Endocrinology, Leiden University Medical Center, Leiden, The Netherlands

    17Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark