| Pituitary diseases in pregnancy. | |
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MedLine Citation:
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PMID: 9880116 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Pituitary adenomas are the most common pituitary disorder affecting pregnancy, and prolactinomas are the most common of the hormone-secreting pituitary adenomas. Hyperprolactinemia must be corrected to allow ovulation and fertility. Bromocriptine has been shown to be safe for use during early gestation. There is less than a 2% risk of microprolactinoma enlargement during pregnancy but a greater than 15% risk of symptomatic enlargement of a macroprolactinoma. Treatment options for patients with macroadenomas include stopping bromocriptine when pregnancy is diagnosed and reinstituting with tumor enlargement, continuous bromocriptine throughout pregnancy, and prepregnancy tumor debulking by surgery. The diagnosis of acromegaly may be difficult to make during pregnancy and relies, in part, on the persistence of the normal pulsatile secretion of growth hormone and loss of this secretory characteristic with a tumor. The growth hormone oversecretion may exacerbate tendencies to gestational diabetes, fluid retention, and hypertension. Treatment for acromegaly and other tumors generally may be deferred until after delivery. There are rare reports of enlargement of clinically nonfunctioning and growth hormone secreting tumors during pregnancy, and surveillance is needed. Tumors may need to be differentiated from lymphocytic hypophysitis. Patients with chronic hypopituitarism usually will need treatment with gonadotropins or pulsatile GnRH to become pregnant and may need increased steroid coverage during labor and delivery. Hypopituitarism developing during pregnancy is usually caused by lymphocytic hypophysitis and usually also will require steroid replacement therapy. Hypopituitarism arising postpartum may be caused by either lymphocytic hypophysitis or Sheehan's syndrome, and the latter may present as an acute or chronic syndrome. Borderline diabetes insipidus may manifest during pregnancy because of increased vasopressin degradation caused by markedly increased levels of placental vasopressinase. Treatment with desmopressin usually is satisfactory. Patients presenting with either anterior or posterior pituitary insufficiency in the peripartum period should always be evaluated for function of the other portion of the pituitary. |
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Authors:
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M E Molitch |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Seminars in perinatology Volume: 22 ISSN: 0146-0005 ISO Abbreviation: Semin. Perinatol. Publication Date: 1998 Dec |
Date Detail:
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Created Date: 1999-03-11 Completed Date: 1999-03-11 Revised Date: 2005-11-16 |
Medline Journal Info:
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Nlm Unique ID: 7801132 Medline TA: Semin Perinatol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 457-70 Citation Subset: IM |
Affiliation:
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Center for Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Medical School, Chicago, IL 60611, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acromegaly
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therapy Diabetes Insipidus / therapy Female Humans Hypopituitarism / therapy Pituitary Diseases* / diagnosis, pathology, therapy Pituitary Neoplasms / therapy Pregnancy Pregnancy Complications* Prolactinoma / therapy |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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