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Pituitary

pp 1–11 | Cite as

Surgical indications for pituitary tumors during pregnancy: a literature review

  • Thomas GraillonEmail author
  • Thomas Cuny
  • Frédéric Castinetti
  • Blandine Courbière
  • Marie Cousin
  • Frédérique Albarel
  • Isabelle Morange
  • Nicolas Bruder
  • Thierry Brue
  • Henry Dufour
Article
  • 16 Downloads

Abstract

Purpose

Surgical indications for pituitary tumors during pregnancy are rare, and are derived from a balance between expected benefits, particularly for maternal benefits, and anesthetic/surgical risks.

Methods

A literature review was performed to define the optimal surgical indications for pituitary adenomas (PA) and other pituitary tumors during pregnancy.

Results

Main benefits are expected in case of critical visual impairment and/or life-threatening endocrine disturbances. Multidisciplinary patient management is systematically required although nonobstetric surgery presents a reasonable risk during pregnancy. The risks of congenital malformation during the first trimester and those of premature birth during the third trimester make the second trimester the optimal period for surgery. In prolactin-secreting, nonsecreting, GH- and TSH-secreting PAs, transsphenoidal surgery (TS) is recommended in cases involving severe visual impairment, characterized by severe visual field deficit, visual acuity impairment, and abnormal optical coherence tomography findings, and when no other medical alternatives are possible and/or sufficient. Uncontrolled and severe Cushing’s disease (CD) during pregnancy increases both maternal and fetal morbimortality, thus justifying TS or sometimes dopamine agonist therapy as a safer alternative. Finally, metyrapone, ketoconazole, or bilateral adrenalectomy could be recommended in certain cases after the failure of medical therapies and/or TS. Surgery is also required for suprasellar meningiomas, craniopharyngiomas, and pituitary cysts in the case of severe visual deficit.

Conclusion

Surgical indications for pituitary tumors are rare during pregnancy; therefore, surgery should be avoided when possible. Further, the second trimester should be considered as the optimal surgical period. Severe visual disturbance and uncontrolled CD are the main surgical indications during pregnancy.

Keywords

Pituitary adenoma Pregnancy Surgery Meningioma Craniopharyngioma Pituitary cyst 

Notes

Acknowledgements

Club Français de l’Hypophyse.

Funding

No Funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all participants included in the study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Thomas Graillon
    • 1
    • 2
    Email author
  • Thomas Cuny
    • 2
    • 3
  • Frédéric Castinetti
    • 2
    • 3
  • Blandine Courbière
    • 4
  • Marie Cousin
    • 5
  • Frédérique Albarel
    • 3
  • Isabelle Morange
    • 3
  • Nicolas Bruder
    • 6
  • Thierry Brue
    • 2
    • 3
  • Henry Dufour
    • 1
    • 2
  1. 1.Neurosurgery DepartmentAix-Marseille Univ, APHM, CHU Timone, La Timone HospitalMarseilleFrance
  2. 2.Aix-Marseille Univ, INSERM, MMGMarseilleFrance
  3. 3.Endocrinology DepartmentAix-Marseille Univ, APHM, CHU ConceptionMarseilleFrance
  4. 4.Centre Clinico-Biologique d’AMP, Pôle Femmes-Parents-Enfants, Hôpital de La Conception, AP-HM, Marseille/Aix Marseille Univ, Avignon Univ, CNRS, IRD, IBMEMarseilleFrance
  5. 5.Cabinet d’OphtalmologieSaint-Rémy de ProvenceFrance
  6. 6.Anesthesiology-Intensive Care DepartmentAix-Marseille Univ, APHM, CHU TimoneMarseilleFrance

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