Surgical indications for pituitary tumors during pregnancy: a literature review View Full Text


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Article Info

DATE

2019-11-06

AUTHORS

Thomas Graillon, Thomas Cuny, Frédéric Castinetti, Blandine Courbière, Marie Cousin, Frédérique Albarel, Isabelle Morange, Nicolas Bruder, Thierry Brue, Henry Dufour

ABSTRACT

PurposeSurgical 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.MethodsA literature review was performed to define the optimal surgical indications for pituitary adenomas (PA) and other pituitary tumors during pregnancy.ResultsMain 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.ConclusionSurgical 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. More... »

PAGES

189-199

References to SciGraph publications

  • 2016-07-30. Predictive model for recovery of visual field after surgery of pituitary adenoma in JOURNAL OF NEURO-ONCOLOGY
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  • 2008-01-23. Tuberculum sellae meningioma symptomatic during pregnancy: pathophysiological considerations in ACTA NEUROCHIRURGICA
  • 2016-07-01. Cabergoline treatment for recurrent Cushing’s disease during pregnancy in HORMONES
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  • 2015-08-13. Cushing’s syndrome during pregnancy caused by adrenal cortical adenoma: a case report and literature review in FRONTIERS OF MEDICINE
  • 2017-03-22. Meningiomas in pregnancy: timing of surgery and clinical outcomes as observed in 104 cases and establishment of a best management strategy in ACTA NEUROCHIRURGICA
  • 2015-07-23. Cushing’s syndrome in pregnancy. Laparoscopic adrenalectomy during pregnancy: the mainstay treatment in JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION
  • 2016-08-27. Pregnancy and acromegaly in PITUITARY
  • 2015-08-12. Growth stabilization and regression of meningiomas after discontinuation of cyproterone acetate: a case series of 12 patients in ACTA NEUROCHIRURGICA
  • 2011-11-15. Prognostic factors of visual field improvement after trans-sphenoidal approach for pituitary macroadenomas: review of the literature and analysis by quantitative method in NEUROSURGICAL REVIEW
  • 2006-02. Intraoperative fetal heart rate monitoring during emergency neurosurgery in a parturient in JOURNAL OF ANESTHESIA
  • 1999-05. Expression of Estrogen Receptors Alpha and Beta in Human Meningiomas in JOURNAL OF NEURO-ONCOLOGY
  • 1999-03-01. Are Obstetrical Personnel Required for Intraoperative Fetal Monitoring during Nonobstetric Surgery? in JOURNAL OF PERINATOLOGY
  • 2000-06-01. Letters to the Editor in JOURNAL OF PERINATOLOGY
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s11102-019-01004-3

    DOI

    http://dx.doi.org/10.1007/s11102-019-01004-3

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1122338415

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/31691893


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    32 schema:description PurposeSurgical 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.MethodsA literature review was performed to define the optimal surgical indications for pituitary adenomas (PA) and other pituitary tumors during pregnancy.ResultsMain 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.ConclusionSurgical 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.
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