Macroprolactinomas and Nonfunctioning Pituitary Adenomas and Pregnancy Outcomes.

Journal article

Objectives

To examine the monitoring, management, and outcomes of pituitary tumors in pregnancy.

Methods

A national, prospective, observational, population-based case series study was conducted in all UK consultant-led obstetric units over 3 years using the UK Obstetric Surveillance System. In order to evaluate rates of adverse pregnancy outcomes, women with a macroprolactinoma (≥10mm) or non-functioning pituitary adenoma, diagnosed before or during pregnancy, were compared to 2 comparison groups: 1) a UKOSS cohort with singleton (n=2205) or twin (n=27) pregnancy and 2) data from the Office of National Statistics (n=2,703,102). Main outcome measures were the incidence, management, and frequency of adverse maternal and offspring outcomes of pituitary tumors in pregnancy.

Results

There were 71 confirmed cases of pituitary tumors in pregnancy (49 macrolactinoma, 16 non-functioning adenomas, 3 acromegaly, 3 Cushing’s disease). The women with pituitary tumors were 4 years older than comparison women (P<0.001). None of the 9 women treated with surgery or radiotherapy prior to pregnancy had symptomatic tumor expansion. This occurred in 6 out of 40 women with macroprolactinomas and 1 out of 7 non-functioning adenomas diagnosed before conception, and in 3 out of 5 women with non-functioning adenomas diagnosed in pregnancy. Two women had pituitary apoplexy, both of whom also had symptoms of expansion of tumor or surrounding pituitary tissue. To within the level of accuracy possible, there was no evidence that pituitary tumors were associated with adverse pregnancy outcomes (pregnancy-induced hypertension, preeclampsia, preterm labor, stillbirth). Women with non-functioning adenomas were more likely to have cesarean section compared to controls (RR 2.06, CI 1.26-3.36, p = 0.035).

Conclusions

The majority of women with macroprolactinomas and non-functioning adenomas have good pregnancy outcomes. Non-functioning pituitary adenomas occur more commonly in pregnancy than previously thought, and can present de novo with symptoms of pituitary expansion in pregnancy.

Authors: Lambert, K; Rees, K; Seed, P; Dhanjal, M; Knight, M

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Lippincott, Williams and Wilkins
• Journal: Obstetrics and Gynecology
• Volume: 129
• Issue: 1
• Pages: 185-194
• Publication date: 2017-01-01
• Acceptance date: 2016-09-13
• DOI: 10.1097/AOG.0000000000001747
• EISSN: 1873-233X
• ISSN: 0029-7844
• Language: English
• Keywords: Journal Article