pituitary disease in pregnancy Flashcards
How does the pituitary change in pregnancy
how do pituitary hormones change
anterior pituitary becomes 35% bigger
Prolactin levels increase 10X
LH and FSH immeasurable
Growth hormone is unchanged
ADH is unchanged but plasma osmolality falls as serum Na falls
Placental hormones speed up the metabolism of ADH
Pituitary levels of ACTH are the same - but the placenta secretes it
How does adrenal hormones change in pregnancy?
Increase in cortisol
Increase in the synthesis of cortisol binding globulin
Increased angiotensin II, renin activity, aldosterone
What causes hyperprolactinaemia
Prolactinoma Normal pregnancy Hypothalamic and pituitary stalk lesions remove the dopaminergic inhibition of prolactin Hypothyroidism Chronic kidney disease Empty sella syndrome Seizures Drugs eg metaclopramide
How do prolactinomas present?
infertility
amenorrhoea
Galactorrhoea
headaches
diabetes insipidis
Visual field disturbance
How do prolactinomas affect pregnancy
They dont really
No reason they shouldnt breastfeed
How does pregnancy affect prolactinomas
They can grow
risk for macroprolactinomas 15% for micro 1.6%
Highest in T3
There is a small risk it will grow so much and cause clinical symptoms
40% of woman will experience remission following pregnancy (higher for micro)
How to manage prolactinomas in pregnancy
Dopamine receptor agonists are typically discontinued
(although they are safe in pregnancy)
They can be continued to prevent tumor expansion
Woman should be reviewed at least once per trimester
If macroprolactinoma or symptomatic they should have formal visual field testing
Assess for sx of growth - headache, visual field changes, or development of DI
Any suspicion - MRI
Safe to treat if needed
Ok to breastfeed on treatment - if able
Rarely surgery or RT after pregnancy
What are the primary and secondary outcomes for HAPO
Primary outcomes Macrosomia >90th Raise cord blood serum C peptide over 90th Primary caesarean Neonatal hypoglycaemia
Secondary outcomes Shoulder dystocia Birth injury Need for NICU Hyperbilirubinemia PET PTB
In the ADIPS consensus guideline what are the moderate and high risk criteria for GDM screening?
If high risk then what should be done?
High risk woman should have a booking GTT
High risk is 1 high risk factor or 2 moderate
BMI over 35
FHx – first degree T2DM or sister with GDM
PCOS
Over 40
Prev elevated glucose level
Prev GDM
Prev macrosomia >4500 g or over 90th
Medications – anti psychotics or steroids
moderate
BMI 25-35
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