Pituitary disorders in pregnancy

During pregnancy there is a normal increase in the volume of the the anteri or pituitary as demonstrated by MRI and hormone secretions which increase ( PRL) or decrease (FSH, LH). During pregnancy pituitary adenomas, especially prolactinomas, may evolve as in non-pregnant women (microadenomas) or diff erently (macroadenomas). In 35 % of cases macroprolactinomas worsen during pregnancy making their medico-surgical management mandatory prior to pregna ncy. Inversely, pregnancy occurring in a subject with a microprolactinoma n ever induces severe local complications so such tumors may be managed surgi cally, or medically. Surgery should be performed for acromegaly or Cushing's disease before or e arly in pregnancy. Subacute pituitary apoplexy (intratumoral hemorrhage) oc curs in about 10 to 15 % of adenomas but, generally speaking. clinical symp toms remain mild in pregnant women. Lymphocytic hypophysitis occurs ar the end of pregnancy, or during the post -partum period. The association of complete pan-hypopituitarism and hypersi gnal on MRI examination may mimic hypophyseal apoplexy and could lead to an d inappropriate surgical procedure.