Pituitary tumors in pregnancy

Pituitary tumors have profound effects on fertility, whereas pregnancy affe cts both the behavior of pituitary tumors and their management. Tumors may impair fertility by hormonal hypersecretion, when functional, or by destruc tion of pituitary hormone-secreting cells. Prolactin hypersecretion inhibit s the hypothalamic-pituitary gonadotropic axis, leading to anovulation, adr enocorticotropic hormone (ACTH) and growth hormone (GH)-secreting tumors ca use infertility due to excess adrenal androgen production. The normal pitui tary and frequently, pituitary tumors, increase in size during pregnancy an d together may cause headaches and impaired vision due to mass effects. For prolactinomas, the risk with microadenomas is very low, although with macr oadenomas, may be as high as 36%, warranting consideration of therapy befor e pregnancy. Prolactinomas frequently respond to dopamine agonists. The lar gest experience has been with bromocriptine, which is considered not to hav e untoward effects on the fetus; less experience exists for cabergoline, al though no safety issues have been raised. Spontaneous tumor regression/remi ssion of prolactinomas may occur after delivery, particularly in those tumo rs first detected during pregnancy. Somatotropinomas may also exhibit sympt omatic enlargement during pregnancy. They usually respond to octreotide, al though the drug's tumor-suppressive activity is less than that of bromocrip tine and experience with this drug in pregnancy is limited. ACTH-secreting tumors cause an increase in maternal and fetal morbidity and mortality. Sur gical therapy is required, because pharmacotherapy exhibits unacceptable to xicity. Treatment of thyroid-stimulating hormone (TSH)-secreting and of non functioning tumors is by surgery.