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How does pregnancy affect the patients with pituitary adenomas: a study on 113 pregnancies from Turkey

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Abstract

Objective

Data regarding pregnancies in relation to pituitary tumors are limited. The effects of pregnancy on pituitary adenomas and the effects of adenoma itself (hormonal activity, mass effects and pituitary insufficiency) and/or treatment on the ongoing gestation and developing fetus were evaluated.

Methods

The study was a retrospective study. A questionnaire involving questions regarding medical history before index gestation, history of related pregnancy, result of index gestation and postpartum follow-up of the patients was filled by the investigator in one of the eight Referral Endocrinology Centers from Turkey.

Results

One hundred and thirteen (83 prolactinoma, 21 acromegaly, 8 NFPA and 1 plurihormonal pituitary adenoma) pregnancies of 87 (60 prolactinoma, 19 acromegaly, 7 NFPA and 1 plurihormonal pituitary adenoma) patients were reviewed. The clinically important pregnancy-related tumor growth of pituitary adenomas was found to be low in previously treated adenomas. Prolactinomas were more likely to increase in size during pregnancy especially if effective prior treatment was lacking. The risk of hypopituitarism is also minimal due to pituitary adenomas during pregnancy. The results of pregnancies did not differ in patients who were on medical treatment or not for prolactinomas and acromegaly during gestation. Neural tube defect and microcephaly associated with maternal cabergoline use; Down syndrome and corpus callosum agenesis associated with maternal bromocriptine use; unilateral congenital cataract, craniosynostosis and microcephaly associated with maternal acromegaly were detected for the first time.

Conclusion

Medical treatment can be safely done stopped in patients with prolactinoma and acromegaly when pregnancy is confirmed and reinstituted when necessary. Prospective studies may help to determine the effects of medical treatment during gestation on the mother and fetus.

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References

  1. Karaca Z, Tanriverdi F, Unluhizarci K, Kelestimur F (2010) Pregnancy and pituitary disorders. Eur J Endocrinol 162(3):453–475

    Article  CAS  PubMed  Google Scholar 

  2. Molitch ME (2003) Pituitary tumors and pregnancy. Growth Horm IGF Res 13(Suppl A):S38–S44

    Article  CAS  PubMed  Google Scholar 

  3. Heaney AP, Fernando M, Melmed S (2002) Functional role of estrogen in pituitary tumor pathogenesis. J Clin Investig 109(2):277–283

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Molitch ME (2011) Pituitary tumors: cabergoline versus bromocriptine: a meta-analysis? Nat Rev Endocrinol 7(5):254–255

    Article  CAS  PubMed  Google Scholar 

  5. Bronstein MD, Paraiba DB, Jallad RS (2011) Management of pituitary tumors in pregnancy. Nat Rev Endocrinol 7(5):301–310

    Article  CAS  PubMed  Google Scholar 

  6. Molitch ME (2015) Endocrinology in pregnancy: management of the pregnant patient with a prolactinoma. Pituitary 172(5):R205–R213

    CAS  Google Scholar 

  7. Lebbe M, Hubinont C, Bernard P, Maiter D (2010) Outcome of 100 pregnancies initiated under treatment with cabergoline in hyperprolactinaemic women. Clin Endocrinol 73(2):236–242

    CAS  Google Scholar 

  8. Ricci E, Parazzini F, Motta T, Ferrari CI, Colao A, Clavenna A, Rocchi F, Gangi E, Paracchi S, Gasperi M, Lavezzari M, Nicolosi AE, Ferrero S, Landi ML, Beck-Peccoz P, Bonati M (2002) Pregnancy outcome after cabergoline treatment in early weeks of gestation. Reprod Toxicol (Elmsford, NY) 16(6):791–793

    Article  CAS  Google Scholar 

  9. Stalldecker G, Mallea-Gil MS, Guitelman M, Alfieri A, Ballarino MC, Boero L, Chervin A, Danilowicz K, Diez S, Fainstein-Day P, Garcia-Basavilbaso N, Glerean M, Gollan V, Katz D, Loto MG, Manavela M, Rogozinski AS, Servidio M, Vitale NM (2010) Effects of cabergoline on pregnancy and embryo-fetal development: retrospective study on 103 pregnancies and a review of the literature. Pituitary 13(4):345–350

    Article  CAS  PubMed  Google Scholar 

  10. Katznelson L, Laws ER Jr, Melmed S, Molitch ME, Murad MH, Utz A, Wass JA (2014) Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 99(11):3933–3951

    Article  CAS  PubMed  Google Scholar 

  11. Kosus A, Kosus N, Turhan NO (2012) Gestational diabetes: comparison of the carpenter and the coustan thresholds with the new thresholds of Turkish women and implications of variations in diagnostic criteria. J Matern Fetal Neonatal Med 25(6):616–622

    Article  PubMed  Google Scholar 

  12. Himmetoglu O, Tiras MB, Gursoy R, Karabacak O, Sahin I, Onan A (1996) The incidence of congenital malformations in a Turkish population. Int J Gynaecol Obstet 55(2):117–121

    Article  CAS  PubMed  Google Scholar 

  13. Kurtoglu S, Hatipoglu N, Mazicioglu MM, Akin MA, Coban D, Gokoglu S, Bastug O (2012) Body weight, length and head circumference at birth in a cohort of Turkish newborns. J Clin Res Pediatr Endocrinol 4(3):132–139

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tuncbilek E, Boduroglu K, Alikasifoglu M (1999) Results of the Turkish congenital malformation survey. Turk J Pediatr 41(3):287–297

    CAS  PubMed  Google Scholar 

  15. Colao A, Abs R, Barcena DG, Chanson P, Paulus W, Kleinberg DL (2008) Pregnancy outcomes following cabergoline treatment: extended results from a 12-year observational study. Clin Endocrinol 68(1):66–71

    Article  CAS  Google Scholar 

  16. Samadi A, Skocic J, Rovet JF (2015) Children born to women treated for hypothyroidism during pregnancy show abnormal corpus callosum development. Thyroid 25(5):494–502

    Article  CAS  PubMed  Google Scholar 

  17. Gillam MP, Molitch ME, Lombardi G, Colao A (2006) Advances in the treatment of prolactinomas. Endocr Rev 27(5):485–534

    Article  CAS  PubMed  Google Scholar 

  18. Krupp P, Monka C (1987) Bromocriptine in pregnancy: safety aspects. Klinische Wochenschrift 65(17):823–827

    Article  CAS  PubMed  Google Scholar 

  19. Webster J (1996) A comparative review of the tolerability profiles of dopamine agonists in the treatment of hyperprolactinaemia and inhibition of lactation. Drug Saf 14(4):228–238

    Article  CAS  PubMed  Google Scholar 

  20. Auriemma RS, Perone Y, Di Sarno A, Grasso LF, Guerra E, Gasperi M, Pivonello R, Colao A (2013) Results of a single-center observational 10-year survey study on recurrence of hyperprolactinemia after pregnancy and lactation. J Clin Endocrinol Metab 98(1):372–379

    Article  CAS  PubMed  Google Scholar 

  21. Karaca Z, Kelestimur F (2011) Pregnancy and other pituitary disorders (including GH deficiency). Best Pract Res Clin Endocrinol Metab 25(6):897–910

    Article  CAS  PubMed  Google Scholar 

  22. Atmaca A, Dagdelen S, Erbas T (2006) Follow-up of pregnancy in acromegalic women: different presentations and outcomes. Exp Clin Endocrinol Diabetes 114(3):135–139

    Article  CAS  PubMed  Google Scholar 

  23. Caron P, Broussaud S, Bertherat J, Borson-Chazot F, Brue T, Cortet-Rudelli C, Chanson P (2010) Acromegaly and pregnancy: a retrospective multicenter study of 59 pregnancies in 46 women. J Clin Endocrinol Metab 95(10):4680–4687

    Article  CAS  PubMed  Google Scholar 

  24. Qureshi A, Kalu E, Ramanathan G, Bano G, Croucher C, Panahloo A (2006) IVF/ICSI in a woman with active acromegaly: successful outcome following treatment with pegvisomant. J Assist Reprod Genet 23(11–12):439–442

    Article  PubMed  PubMed Central  Google Scholar 

  25. Colao A, Merola B, Ferone D, Lombardi G (1997) Acromegaly. J Clin Endocrinol Metab 82(9):2777–2781

    Article  CAS  PubMed  Google Scholar 

  26. Cozzi R, Attanasio R, Barausse M (2006) Pregnancy in acromegaly: a one-center experience. Eur J Endocrinol 155(2):279–284

    Article  CAS  PubMed  Google Scholar 

  27. Herman-Bonert V, Seliverstov M, Melmed S (1998) Pregnancy in acromegaly: successful therapeutic outcome. J Clin Endocrinol Metab 83(3):727–731

    CAS  PubMed  Google Scholar 

  28. Grynberg M, Salenave S, Young J, Chanson P (2010) Female gonadal function before and after treatment of acromegaly. J Clin Endocrinol Metab 95(10):4518–4525

    Article  CAS  PubMed  Google Scholar 

  29. Takano T, Saito J, Soyama A, Ito H, Iizuka T, Yoshida T, Nishikawa T (2006) Normal delivery following an uneventful pregnancy in a Japanese acromegalic patient after discontinuation of octreotide long acting release formulation at an early phase of pregnancy. Endocr J 53(2):209–212

    Article  PubMed  Google Scholar 

  30. Blackhurst G, Strachan MW, Collie D, Gregor A, Statham PF, Seckl JE (2002) The treatment of a thyrotropin-secreting pituitary macroadenoma with octreotide in twin pregnancy. Clin Endocrinol 57(3):401–404

    Article  CAS  Google Scholar 

  31. Fassnacht M, Capeller B, Arlt W, Steck T, Allolio B (2001) Octreotide LAR treatment throughout pregnancy in an acromegalic woman. Clin Endocrinol 55(3):411–415

    Article  CAS  Google Scholar 

  32. Cheng V, Faiman C, Kennedy L, Khoury F, Hatipoglu B, Weil R, Hamrahian A (2012) Pregnancy and acromegaly: a review. Pituitary. 15(1):59–63

    Article  PubMed  Google Scholar 

  33. Maffei P, Tamagno G, Nardelli GB, Videau C, Menegazzo C, Milan G, Calcagno A, Martini C, Vettor R, Epelbaum J, Sicolo N (2010) Effects of octreotide exposure during pregnancy in acromegaly. Clin Endocrinol 72(5):668–677

    Article  CAS  Google Scholar 

  34. Brian SR, Bidlingmaier M, Wajnrajch MP, Weinzimer SA, Inzucchi SE (2007) Treatment of acromegaly with pegvisomant during pregnancy: maternal and fetal effects. J Clin Endocrinol Metab 92(9):3374–3377

    Article  CAS  PubMed  Google Scholar 

  35. Ersoy H, Sarı O, Aydoğan Ü, Akbulut H, Önge K, Yenen MC, Sağlam K (2011) Hypertensıon prevalance in pregnant women referred to the gynecology and obstetrics clinic of a faculty of medicine. Turk Nephrol Dial Transplant J 20(2):187–191

    Article  Google Scholar 

  36. Cheng S, Grasso L, Martinez-Orozco JA, Al-Agha R, Pivonello R, Colao A, Ezzat S (2012) Pregnancy in acromegaly: experience from two referral centers and systematic review of the literature. Clin Endocrinol 76(2):264–271

    Article  Google Scholar 

  37. de Heide LJ, van Tol KM, Doorenbos B (2004) Pituitary apoplexy presenting during pregnancy. Neth J Med 62(10):393–396

    PubMed  Google Scholar 

  38. Masding MG, Lees PD, Gawne-Cain ML, Sandeman DD (2003) Visual field compression by a non-secreting pituitary tumour during pregnancy. J R Soc Med 96(1):27–28

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Molitch ME (2006) Pituitary disorders during pregnancy. Endocrinol Metab Clin N Am 35(1):99–116, vi

    Article  Google Scholar 

  40. Murata Y, Ando H, Nagasaka T, Takahashi I, Saito K, Fukugaki H, Matsuzawa K, Mizutani S (2003) Successful pregnancy after bromocriptine therapy in an anovulatory woman complicated with ovarian hyperstimulation caused by follicle-stimulating hormone-producing plurihormonal pituitary microadenoma. J Clin Endocrinol Metab 88(5):1988–1993

    Article  CAS  PubMed  Google Scholar 

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Author information

Author notes

  1. N. Ozbey: Deceased in 2014.

Authors and Affiliations

  1. Department of Endocrinology, Erciyes University Medical School, 38039, Kayseri, Turkey

    Z. Karaca, F. Tanriverdi, K. Unluhizarci & F. Kelestimur

  2. Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

    S. Yarman & N. Ozbey

  3. Department of Endocrinology, İstanbul University Cerrahpaşa Medical School, Istanbul, Turkey

    I. Ozbas & P. Kadioglu

  4. Department of Endocrinology, Gazi University Medical School, Ankara, Turkey

    M. Akturk

  5. Department of Endocrinology, İstanbul Medipol University Medical School, Istanbul, Turkey

    F. Kilicli & H. S. Dokmetas

  6. Department of Endocrinology, Ondokuz Mayis University Medical School, Samsun, Turkey

    R. Colak & H. Atmaca

  7. Department of Endocrinology, Kocaeli University Medical School, Kocaeli, Turkey

    Z. Canturk

  8. Department of Endocrinology, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey

    Y. Altuntas

  9. Department of Pediatric Endocrinology, Erciyes University Medical School, Kayseri, Turkey

    N. Hatipoglu

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  1. Z. Karaca
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  9. H. Atmaca
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  13. N. Hatipoglu
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Corresponding author

Correspondence to F. Kelestimur.

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Authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/r national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Karaca, Z., Yarman, S., Ozbas, I. et al. How does pregnancy affect the patients with pituitary adenomas: a study on 113 pregnancies from Turkey. J Endocrinol Invest 41, 129–141 (2018). https://doi.org/10.1007/s40618-017-0709-8

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  • DOI: https://doi.org/10.1007/s40618-017-0709-8

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