Pregnancy and pituitary disorders
The pituitary gland is altered by both anatomical and physiological changes during pregnancy. The most striking finding is the physiological enlargement of the pituitary gland as a result of lactotroph hyperplasia. Hormonal evaluation of pregnant women requires special consideration due to the emergence of the placenta as a new source of hormone production, changes in binding globulin levels and resistance to hormones such as glucocorticoids.
Pituitary adenomas may adversely affect pregnancy by their hormone production and pose a potential risk of tumour growth. Prolactinomas are the most common pituitary adenomas encountered during pregnancy since the disease is common among women of reproductive age and fertility can be achieved easily after medical treatment. Acromegaly is the second most common pituitary adenoma seen in relation to gestation after prolactinomas. Medical therapy can be ceased safely after confirmation of pregnancy in both GH and PRL secreting pituitary adenomas. The risk of tumour growth during gestation is low in most cases of acromegaly and prolactinomas. Cushings disease is rare and most cases with Cushings syndrome are caused by adrenal adenomas, unlike in non-pregnant women. Cushings disease adversely affects pregnancy, therefore prompt diagnosis and treatment according to gestational period are essential. Other hormonal and non-functional tumours are rarer and have been presented as case reports.
Sheehans syndrome and lymphocytic hypophysitis are other pituitary disorders associated with pregnancy. They lead to hypopituitarism, sometimes with delays in diagnosis and difficulties in differential diagnosis. Pregnancy is not common among patients with hypopituitarism or pituitary adenomas due to altered gonadotroph functions. Ovulation induction is essential for fertility achievement, but the replacement of other deficient pituitary hormones, including GH, also plays an important role in the preparation of the uterus for implantation. Due to increased fecundity by improved assisted reproductive technologies and treatment methods, the number of pregnant women with pituitary disorders seen in clinical practice is increasing which necessitates special attention.
Declaration of interest: The author declares that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.