CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2019; 79(04): 365-374
DOI: 10.1055/a-0794-7587
GebFra Science
Review/Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Pituitary Disease in Pregnancy: Special Aspects of Diagnosis and Treatment?

Article in several languages: English | deutsch
Stephan Petersenn
1   ENDOC Praxis für Endokrinologie, Andrologie und medikamentöse Tumortherapie, Hamburg, Germany
,
Mirjam Christ-Crain
2   Endokrinologie, Diabetologie & Metabolismus. Universitätsspital Basel, Basel, Switzerland
,
Michael Droste
3   Endokrinologie, Diabetologie, Hormonanalytik. MEDICOVER MVZ, Oldenburg, Germany
,
Reinhard Finke
4   Praxis an der Kaisereiche (üBAG), Berlin-Friedenau, Germany
,
Jörg Flitsch
5   Klinik und Poliklinik für Neurochirurgie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
,
Ilonka Kreitschmann-Andermahr
6   Neurochirurgische Klinik, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
,
Anton Luger
7   Universitätsklinik für Innere Medizin III, Klinische Abteilung für Endokrinologie & Stoffwechsel, Medizinische Universität Wien, Wien, Austria
,
Jochen Schopohl
8   Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
,
Günter Stalla
8   Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
9   Medicover Neuroendokrinologie, München, Germany
› Author Affiliations
Further Information

Publication History

received 09 August 2018
revised 14 October 2018

accepted 10 November 2018

Publication Date:
06 March 2019 (online)

Abstract

The diagnosis and treatment of pituitary disease in pregnancy represents a special clinical challenge. Not least because there is very little data on the treatment of pregnant patients with pituitary disorders. A selective search of the literature was carried out with the aim of compiling evidence about the diagnosis and treatment of pituitary disease in pregnancy. The search covered the databases PubMed/MEDLINE including PubMed Central and also used the Livivo (ZB MED) search engine. Recent studies were evaluated for recommendations about the care of pregnant patients with hormone-inactive and hormone-active pituitary adenomas (prolactinoma, acromegaly and Cushingʼs disease), pituitary insufficiency, pituitary apoplexy and hypophysitis. The most well-established forms of treatment are for prolactinoma, due to the incidence of this disease and its impact on fertility. When pregnancy has been confirmed, prolactinoma treatment with dopamine agonists should be paused. Although microprolactinomas rarely increase significantly in size after the administration of dopamine agonists is discontinued, symptomatic tumor growth of macroprolactinomas can occur. In such cases, treatment with dopamine agonists can be resumed. If the primary tumor is large and the risk that it will continue to grow is high, it may be necessary to continue medical treatment from the start of pregnancy. If one of the partners has a pituitary disorder, it is often still possible for many couples to achieve their wish of having children if they receive medical support to plan and the pregnancy is carefully monitored. Given the complexity of pituitary disease, pregnant patients with pituitary disorders should be cared for and treated by a multidisciplinary team in centers specializing in the diagnosis and treatment of pituitary disease.

 
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