Pituitary Adenoma

Question 1

What is pituitary microadenoma?

Answer 1

Benign slow-growing tumor of the pituitary measuring less than 10mm.

Question 2

What is pituitary macroadenoma?

Answer 2

Benign slow-growing tumor of the pituitary measuring greater than 10mm.

Question 3

How do you counsel a patient with a known pituitary micro and macroadenoma about risks of pregnancy?

Answer 3

Management:
Visual field defects sometimes develop during pregnancy in patients with a pituitary adenoma.
-Follow up with optometrist for baseline visual field testing

Risks:

• Increased intracranial pressure
• Visual deterioration
• Increasing neurologic deficit

Pharmacologic intervention should symptoms arise (e.g., corticosteroids, bromocriptine) may be adequate.

Question 4

What is the likelihood a microadenoma will increase in size?

Answer 4

Pregnancy can lead to a slight increase in tumor size.

• **Suggested mechanisms include
• accelerated growth rate,
• vascular engorgement
• increased fluid content

*** supportive evidence for these mechanisms is lacking

Question 5

How do you follow pregnant women with microadenoma and evidence of increasing size?

Answer 5

Management:
Visual field defects sometimes develop during pregnancy in patients with a pituitary adenoma.
-Follow up with optometrist for baseline visual field testing
-vaginal delivery with adequate regional anesthesia
-shortening of the second stage of labor by use of low forceps (to prevent any increase in intracranial pressure associated with the abdominal pushing efforts of this stage)

Question 6

If patient conceives while taking bromocriptine for a pituitary microadenoma, how do you counsel her about continuing or discontinuing the medication in pregnancy?

Answer 6

Pregnant patients with untreated microadenomas: -2.3% experienced visual disturbances

• 4.8% experienced headaches
• 0.6% had diabetes insipidus.

Pregnant women with macroadenomas:

• visual disturbances in 15.3%
• headaches in 5.3%
• diabetes insipidus 1.4%

Bromocriptine use during pregnancy is not believed to increase the risk of congenital anomalies.

Question 7

If patient conceives while taking cabergoline for a pituitary microadenoma, how do you counsel her about continuing or discontinuing the medication in pregnancy?

Answer 7

Pregnant patients with untreated microadenomas: -2.3% experienced visual disturbances

• 4.8% experienced headaches
• 0.6% had diabetes insipidus.

Pregnant women with macroadenomas:

• visual disturbances in 15.3%
• headaches in 5.3%
• diabetes insipidus 1.4%

Use of cabergoline is not expected to increase the risk of congenital anomalies.

Question 8

What patients require treatment for pituitary microadenoma while pregnant?

Answer 8

• Increased intracranial pressure
• Visual deterioration
• Increasing neurologic deficit