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

Luger, A., Broersen, L., Biermasz, N. R., Biller, B., Buchfelder, M., Chanson, P., Jorgensen, J., Kelestimur, F., Llahana, S. ORCID: 0000-0002-3606-5370, Maiter, D., Mintziori, G., Petraglia, F., Verkauskiene, R., Webb, S. M. and Dekkers, O. M. (2021). ESE Clinical Practice Guideline on functioning and nonfunctioning pituitary adenomas in pregnancy. European Journal of Endocrinology, 185(3), pp. 1-33. doi: 10.1530/EJE-21-0462

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.

Publication Type: Article
Additional Information: The definitive version is now freely available at https://doi.org/10.1530/EJE-21-0462, 2021
Subjects: R Medicine > RG Gynecology and obstetrics
R Medicine > RT Nursing
Departments: School of Health Sciences > Nursing
Date available in CRO: 06 Sep 2021 10:09
Date deposited: 6 September 2021
Date of acceptance: 14 June 2021
Date of first online publication: 23 August 2021
URI: https://openaccess.city.ac.uk/id/eprint/26687
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