Impact of pregnancy on pituitary disorders

Česká verzia

Authors: J. Marek
Authors place of work: III. interní klinika 1. lékařské fakulty UK a VFN v Praze, přednosta prof. MU Dr. Štěpán Svačina, DrSc., MBA
Published in the journal: Vnitř Lék 2013; 59(6): 472-477
Category: 80th birthday prof. MUDr. Karla Horkého, DrSc., FACP (Hon.)

Summary

In pregnancy, the volume of pituitary increases by multiplication of lactotopic and gonadotropic cells and developing placenta is the source of numerous hormones and enzymes that significantly affect and alter the function of the endocrine system. This naturally has an impact on the course of pituitary disorders and their treatment. The most common disorders of pituitary gland, which we can meet in pregnancy, are adenomas, particularly prolactinomas, and functionless adenomas. During pregnancy we avoid the treatment of microprolactinomas, but in macroprolactinomas where there is the risk of their enlargement by stimulation of placental estrogens, we administer preventively the dopaminergic agonists. Patients with acromegaly usually do not need the treatment during pregnancy, unless there is a danger to damage the visual pathway or heavy headaches occur. ACTH‑ secreting adenomas (Cushing‘s disease) in pregnancy are rare, they are difficult to diagnose but existing hypercortisolism is very dangerous to fetus and may damage even mother. Large functionless adenomas, unless treated before pregnancy, may damage the visual pathway. The volume of the enlarged pituitary gland in pregnancy and sometimes even of the functionless adenoma adenoma, may be reduced by cabergoline, so that the urgent neurosurgery in pregnancy is very rare. A typical disease that occurs primarily in pregnant women is autoimmune lymphocytic hypophysitis. Diagnosis is established on the basis of headaches and symptoms and signs of the deficits of adrenocorticotropic and thyreotropic function usually in the last third of pregnancy or in the first six months after birth, using a specific image in magnetic resonance. Treatment is limited to hormone replacement. It is also possible to meet pregnant women with deficient pituitary functions. In hypocortical women with exception of strains like as pregnancy vomiting, doses of hydrocortisone replacement usually do not change until birth. Childbirth, however, must be secured by increasing the doses of corticosteroids. Careful replacement of thyroid hormones in hypothyroid women is very important for the development of fetus. In women treated with growth hormone its administration during pregnancy may be omitted because the placental growth hormone takes over its function. Desmopressin dose for diabetes insipidus in pregnancy is unchanged – desmopressin is resistant to placental vasopressinases. However, their effects may cause manifestation of partial diabetes insipidus, which was compensated so far.

Key words:
pituitary – pregnancy – prolactinoma – acromegaly – Cushing’s disease – lymphocytic hypophysitis – hypopituitarism

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