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01-04-2020 | Meningioma

Surgical indications for pituitary tumors during pregnancy: a literature review

Authors: Thomas Graillon, Thomas Cuny, Frédéric Castinetti, Blandine Courbière, Marie Cousin, Frédérique Albarel, Isabelle Morange, Nicolas Bruder, Thierry Brue, Henry Dufour

Published in: Pituitary | Issue 2/2020

Abstract

Purpose

Surgical indications for pituitary tumors during pregnancy are rare, and are derived from a balance between expected benefits, particularly for maternal benefits, and anesthetic/surgical risks.

Methods

A literature review was performed to define the optimal surgical indications for pituitary adenomas (PA) and other pituitary tumors during pregnancy.

Results

Main benefits are expected in case of critical visual impairment and/or life-threatening endocrine disturbances. Multidisciplinary patient management is systematically required although nonobstetric surgery presents a reasonable risk during pregnancy. The risks of congenital malformation during the first trimester and those of premature birth during the third trimester make the second trimester the optimal period for surgery. In prolactin-secreting, nonsecreting, GH- and TSH-secreting PAs, transsphenoidal surgery (TS) is recommended in cases involving severe visual impairment, characterized by severe visual field deficit, visual acuity impairment, and abnormal optical coherence tomography findings, and when no other medical alternatives are possible and/or sufficient. Uncontrolled and severe Cushing’s disease (CD) during pregnancy increases both maternal and fetal morbimortality, thus justifying TS or sometimes dopamine agonist therapy as a safer alternative. Finally, metyrapone, ketoconazole, or bilateral adrenalectomy could be recommended in certain cases after the failure of medical therapies and/or TS. Surgery is also required for suprasellar meningiomas, craniopharyngiomas, and pituitary cysts in the case of severe visual deficit.

Conclusion

Surgical indications for pituitary tumors are rare during pregnancy; therefore, surgery should be avoided when possible. Further, the second trimester should be considered as the optimal surgical period. Severe visual disturbance and uncontrolled CD are the main surgical indications during pregnancy.

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Title: Surgical indications for pituitary tumors during pregnancy: a literature review
Authors: Thomas Graillon
Thomas Cuny
Frédéric Castinetti
Blandine Courbière
Marie Cousin
Frédérique Albarel
Isabelle Morange
Nicolas Bruder
Thierry Brue
Henry Dufour
Publication date: 01-04-2020
Publisher: Springer US
Keywords: Meningioma
Pituitary Adenoma
Craniopharyngioma
Meningioma
Dopamine Agonist
Published in: Pituitary / Issue 2/2020
Print ISSN: 1386-341X
Electronic ISSN: 1573-7403
DOI: https://doi.org/10.1007/s11102-019-01004-3

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Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

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Image Credits

STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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National trends in hospital readmission following transsphenoidal surgery for pituitary lesions

Association of NM23 polymorphisms and clinicopathological features and recurrence of invasive pituitary adenomas

Granulomatous hypophysitis causing compression of the internal carotid arteries reversible with azathioprine and rituximab treatment

Surgical management of pituitary adenomas: does age matter?

Predictive factors for responses to primary medical treatment with lanreotide autogel 120 mg in acromegaly: post hoc analyses from the PRIMARYS study

Common tools for pituitary adenomas research: cell lines and primary cells

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage