Table 5.
Pituitary adenomas in pregnancy
| Symptomatic growth during pregnancy | Radiological growth during pregnancy | Peri-pregnancy change in adenoma size | |
|---|---|---|---|
|
PRL-secreting (311) 753 pregnancies 652 patients 13 studies |
All adenomas (n = 578): 9.0% (95% CI: 6.8-11.6) Microadenomas (n = 46): 15.2% (95% CI: 15.2; 6.3-28.9) Macroadenomas (n = 118): 30.5% (95% CI: 22.4-39.7) |
All adenomas (n = 376): 10.6% (95% CI: 7.7-14.2) Microadenomas (n = 104): 14.4% (95% CI: 8.3-22.7) Macroadenomas (n = 137): 13.9% (95% CI: 8.6-20.8) |
Population
n = 175 in 4 studies with available data before and after pregnancy No change (1 study) • 5.0 mm (95% CI: 1.6-14.4) before and 5.0 mm (95% CI: 0-12.0) after pregnancy Increased size (2 studies) • Range, 0.0-1.4 cm; mean 0.7 cm in macroadenomas • Median 4 mm (range, 2-8); 3.0 mm in macroadenomas and 0.5 mm in microadenomas Decreased size (1 study) • Median 1 mm (range, −19 to + 12); no change (range, −5 to + 6) in microadenomas and 6.5 mm reduction (range, −19 to + 12) in macroadenomas |
| PRL-secreting (315) | Macroadenomas with no prior surgery/radiation (n = 238): 21.0% Macroadenomas with prior surgery/radiation (n = 148): 4.7% |
N/A | N/A |
|
GH-secreting (311) 128 pregnancies 97 patients 4 studies |
All adenomas (n = 128): 7.0% (95% CI: 3.3-12.9) Microadenomas (n = 10): 30.0% (95% CI: 6.7-65.2) Macroadenomas (n = 97): 4.1% (95% CI: 1.1-10.2) |
All adenomas (n = 111): 5.4% (95% CI: 2.0-11.4) Microadenomas (n = 8): 25.0% (95% CI: 3.2-65.1) Macroadenomas (n = 82): 3.7% (95% CI: 0.8-10.3) |
N/A |
|
Clinically nonsecreting (311, 327) Observational study of > 2000 patients 71 confirmed pituitary macroadenomas |
Macroadenomas (n = 16): 37.5% (95% CI: 15.2-64.6) | Macroadenomas (n = 4): 25% (95% CI: 7.3-52.4) | N/A |
|
TSH-secreting (316) 3 cases |
Macroadenomas: 2 of 3 cases | Macroadenomas: 2 of 3 cases |
No change (1 case)
• Treated with continuous octreotide throughout pregnancy Increased size (2 cases) • Extensive enlargement during pregnancy despite continuation of bromocriptine • Increased at 6 months of pregnancy and octreotide withdrawal, reduction back toward baseline after octreotide reintroduction |