Grupo "Enfermedades de Hipófisis" (CIBERER 747), II-B Hospital Sant Pau, Barcelona, España; Servicio de Endocrinología, Hospital General de Catalunya, Sant Cugat del Vallès, España.
Endocrinol Diabetes Nutr (Engl Ed). 2021 Mar;68(3):184-195. doi: 10.1016/j.endinu.2020.07.007. Epub 2021 Jan 7.
Pregnancy results in a significant change in both pituitary gland size and function. Due to this physiological adaptation, the diagnosis and management of pituitary diseases during pregnancy represents a particularly complex challenge. The presence of a functioning pituitary adenoma may be harmful to the health of the mother and fetus, and scientific evidence regarding the safety of drugs normally used to control hormone excess during pregnancy is scarce. In addition, pregnancy may be associated with the risk of the growth of a pre-existing pituitary adenoma. This review focuses on the diagnostic challenges in pregnant women with adenomas secreting prolactin, growth hormone, or adrenocorticotropic hormone. Some evidence-based recommendations for the treatment of these conditions during pregnancy are provided, and algorithms that could help monitor a pituitary adenoma during pregnancy are examined. Mention is also made of how hormone replacement therapy can be optimised in pregnant women with hypopituitarism. Finally, differential diagnosis between Sheehan's syndrome and lymphocytic hypophysitis, two pituitary disorders that may occur during pregnancy or delivery, is discussed.
妊娠会导致垂体大小和功能发生显著变化。由于这种生理适应，妊娠期间的垂体疾病的诊断和管理是一个特别复杂的挑战。功能性垂体腺瘤的存在可能对母亲和胎儿的健康有害，并且关于妊娠期间通常用于控制激素过多的药物安全性的科学证据很少。此外，妊娠可能与先前存在的垂体腺瘤生长的风险相关。本篇综述重点介绍了分泌催乳素、生长激素或促肾上腺皮质激素的腺瘤孕妇的诊断挑战。针对这些情况下的妊娠治疗提供了一些基于证据的建议，并检查了有助于在妊娠期间监测垂体腺瘤的算法。还提到了如何优化患有垂体功能减退症的孕妇的激素替代疗法。最后，讨论了妊娠或分娩期间可能发生的两种垂体疾病，席汉氏综合征和淋巴细胞性垂体炎之间的鉴别诊断。
