Pregnancies are rare in women with
pituitary adenomas, which may relate to
hormone excess from secretory subtypes such as
prolactinomas or
corticotroph adenomas. Decreased fertility may also result from pituitary
hormone deficiencies due to compression of the gland by large tumours and/or surgical or
radiation treatment of the lesion. Counselling premenopausal women with
pituitary adenomas about their chance of conceiving spontaneously or with assisted reproductive technology, and the optimal pre-conception treatment, should start at the time of initial diagnosis. The normal physiological changes during pregnancy need to be considered when interpreting endocrine tests in women with
pituitary adenomas. Dose adjustments in
hormone substitution
therapies may be needed across the trimesters. When medical
therapy is used for pituitary
hormone excess, consideration should be given to the known efficacy and safety data specific to pregnant women for each therapeutic option. In healthy women, pituitary gland size increases during pregnancy. Since some
pituitary adenomas also enlarge during pregnancy, there is a risk of
visual impairment, especially in women with macroadenomas or tumours near the optic chiasm.
Pituitary apoplexy represents a rare acute complication of
adenomas requiring surveillance, with surgical intervention needed in some cases. This guideline describes the choice and timing of diagnostic tests and treatments from the pre-conception stage until after delivery, taking into account
adenoma size, location and endocrine activity. In most cases, pregnant women with
pituitary adenomas should be managed by a multidisciplinary team in a centre specialised in the treatment of such tumours.