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Optimization of Care for Women with Complex Pituitary Tumors Who Seek Fertility

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Pituitary Disorders throughout the Life Cycle

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Abstract

In patients with secretory tumors and hypopituitarism who wish to conceive, optimal fertility outcomes depend on the appropriate treatment of both hormone excess and deficiencies. Pituitary lesions that invade or are in close proximity of the chiasm should be treated prior to attempt to conceive in order to avoid visual loss with the enlargement of the pituitary that occurs during pregnancy. States of pituitary hormone excess such as acromegaly, hypercortisolism, hyperprolactinemia, and hyperthyroidism should be treated prior to fertility treatment. Evaluation for central adrenal insufficiency should be performed prior to attempts to conceive. In patients found with central adrenal insufficiency, physiologic doses of hydrocortisone are indicated with adjustments based on clinical correlation with signs and symptoms. Stress doses are needed for surgical reproductive procedures that require general anesthesia. Excessive exogenous steroid may impair ovulatory function and should be avoided. In patients with central hypothyroidism, the free thyroxine level should be optimized in the upper ranges of normal. TSH is not a good marker in the setting central hypothyroidism. In growth hormone-deficient states, growth hormone (GH) replacement may improve oocyte quality and yield during assisted reproduction, but GH is not approved for use during pregnancy. We present here a case of a female patient with active acromegaly and multiple pituitary hormone deficiencies who achieved pregnancy after ovulation induction.

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Author information

Authors and Affiliations

  1. Neuroendocrine and Pituitary Tumor Clinical Center, Boston, MA, USA

    Lisa B. Nachtigall

  2. Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA

    Lisa B. Nachtigall

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  1. Lisa B. Nachtigall
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Correspondence to Lisa B. Nachtigall .

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Editors and Affiliations

  1. Mayo Clinic, Jacksonville, FL, USA

    Susan L. Samson

  2. Emory University School of Medicine, Atlanta, GA, USA

    Adriana G. Ioachimescu

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Nachtigall, L.B. (2022). Optimization of Care for Women with Complex Pituitary Tumors Who Seek Fertility. In: Samson, S.L., Ioachimescu, A.G. (eds) Pituitary Disorders throughout the Life Cycle. Springer, Cham. https://doi.org/10.1007/978-3-030-99918-6_12

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  • DOI: https://doi.org/10.1007/978-3-030-99918-6_12

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-99917-9

  • Online ISBN: 978-3-030-99918-6

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