Pituitary Disorders During Pregnancy and Lactation

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2020
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Jallad, R. S.; Glezer, A.; Machado, M. C.; Bronstein, M. D.. Pituitary Disorders During Pregnancy and Lactation. In: . MATERNAL-FETAL AND NEONATAL ENDOCRINOLOGY: PHYSIOLOGY, PATHOPHYSIOLOGY, AND CLINICAL MANAGEMENT: ELSEVIER, 2020. p.259-286.
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The presence of a pituitary adenoma may affect the course of pregnancy, as the hormonal changes related to these tumors may lead to early termination of pregnancy due to failure to implant or maintain the conceptus or early embryo. The age-adjusted incidence rate of pituitary adenomas is estimated to be 3.4 cases per 100,000 inhabitants per year. They are usually benign adenomas, with a peak incidence in young women of childbearing age. The management of pituitary adenomas during pregnancy depends on its clinical presentation and should be adapted to the individual case. Most pregnant women with pituitary adenomas can be safely observed with frequent neuro-ophthalmologic assessments and MRI, if needed. Among women with pituitary adenomas, prolactin (PRL)-secreting pituitary adenomas (prolactinomas) are the most common. Dopamine agonists (DAs) are the gold standard treatment for prolactinomas; they normalize serum PRL levels, leading to tumor shrinkage in more than 80% of cases and restoration of eugonadism. In micro- and intrasellar macroprolactinomas, DA is usually withdrawn when pregnancy is confirmed. In pregnant women with acromegaly, hormonal control is often achieved in most patients, allowing the withdrawal of clinical treatment. Due to similar clinical features and changes in the hypothalamic-pituitary-adrenal (HPA) axis during pregnancy, the diagnosis of Cushing disease (CD) during gestation can be difficult. Similar to nonpregnant women, surgery is the first treatment option for CD during pregnancy, if complications develop. Overall, pregnancy in women harboring clinically nonfunctioning tumors is a rare event. Causes of hypopituitarism that are most specific to pregnancy include lymphocytic hypophysitis and postpartum pituitary infarction (Sheehan’s syndrome). During pregnancy, the priority for hormonal replacement should be glucocorticoid, followed by thyroid hormone. Doses should be adjusted throughout pregnancy based on the severity and nature of the condition. For this reason, it is necessary to follow these patients regularly and closely during pregnancy. Central or nephrogenic diabetes insipidus (DI) can also be observed during pregnancy. Therefore, a detailed medical history is essential for the differential diagnoses of DI. Primary polydipsia and head trauma should be excluded. Ingestion of drugs such as lithium, mannitol, diuretics, and anticholinergic drugs should be questioned. Management of pituitary disease during pregnancy in otherwise healthy women poses difficult challenges from various perspectives. However, a multidisciplinary approach, involving the endocrinologist, obstetrician, neurosurgeon, and anesthesiologist, will allow a better outcome for both mother and fetus during pregnancy. © 2020 Elsevier Inc. All rights reserved.
Palavras-chave
Acromegaly, Cushing disease, Diabetes insipidus, Hypopituitarism, Lymphocitic hypophysitis, Pituitary tumors, Pregnancy, Prolactinoma, Sheehan’s syndrome
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https://observatorio.fm.usp.br/handle/OPI/51282
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Coleções
Livros e Capítulos de Livros - HC/ICHC
Livros e Capítulos de Livros - LIM/25
Livros e Capítulos de Livros - ODS/03