Rav Endocrinology Pituitary / Pregnancy

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prolactinomas/ dopamin
risk of fetal malform
when could yo start breast feeding
when could be growth of adenoma and what todo

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For women with prolactinomas, dopamine agonists are stopped once pregnancy is achieved. There are no documented risks of fetal malformations or other adverse pregnancy outcomes for these agents; the collection of available data on the safety of bromocriptine is approximately 10-fold larger than that for cabergoline. Dopamine agonists are reinstituted when breast feeding is completed. Symptomatic growth occurs in approximately 30% of macroprolactinomas and 3% of microprolactinomas in the second or third trimester, which necessitates reinstitution of the dopamine agonist, transsphenoidal surgical decompression, or delivery if the pregnancy is sufficiently advanced

Front 2

risk of fetal malform
when could yo start breast feeding

Back 2

The diagnosis of acromegaly during pregnancy can be difficult because the placental variant of GH increases substantially in the second half of pregnancy as measured in the standard GH assays. It may be necessary to wait until the postpartum period to confirm the diagnosis. As with prolactinomas, dopamine agonists (if taken) are stopped when the pregnancy is diagnosed. Somatostatin analogues also are generally stopped when pregnancy is planned or diagnosed. Although no adverse outcomes have occurred in the 14 reported cases in which somatostatin analogues have been used by pregnant women, the facts that these drugs cross the placenta and that there are somatostatin receptors in many fetal tissues make use of such drugs during pregnancy problematic. Hypertension and gestational diabetes mellitus in pregnant women with acromegaly can generally be managed conventionally.

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Active Cushing syndrome, including Cushing disease

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Active Cushing syndrome, including Cushing disease, is associated with a substantially increased risk of prematurity and stillbirth. The diagnosis of Cushing syndrome during pregnancy may be difficult because signs and symptoms overlap with those of normal pregnancy; 24-hour urine free cortisol and serum cortisol levels increase in normal pregnancy, and there is impaired suppression of cortisol levels by dexamethasone. Outcome analyses suggest that pregnant patients with newly diagnosed Cushing syndrome of all causes should undergo surgery, unless they are near term.

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Clinically Nonfunctioning Adenomas and Thyroid-Stimulating Hormone–Secreting Adenomas in Pregnancy

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Clinically Nonfunctioning Adenomas and Thyroid-Stimulating Hormone–Secreting Adenomas in Pregnancy

There are few reports of women with either clinically nonfunctioning adenomas or thyroid-stimulating hormone–secreting adenomas becoming pregnant. Hyperthyroidism needs to be controlled, but pituitary surgery for these tumors can usually be deferred until after delivery.

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Hypopituitarism During Pregnancy

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Only thyroid and adrenal hormone replacement need be performed during pregnancy in patients with hypopituitarism. Extrapolating from data of patients with primary hypothyroidism, physicians usually increase the levothyroxine dosage by 0.025 mg daily at the end of the first trimester and by another 0.025 mg daily at the end of the second trimester. Corticosteroid replacement does not have to be increased, except in women under stress or undergoing labor