Prager D, Braunstein G D
Department of Medicine, Cedars-Sinai Medical Center-University of California at Los Angeles School of Medicine, USA.
Endocrinol Metab Clin North Am. 1995 Mar;24(1):1-14.
A number of morphologic and physiologic changes accompany pregnancy such as an increase in lactotrophs and prolactin production, and a decrease in gonadotropins and GH. The hormonal milieu can affect patients with prolactinomas, especially macroadenomas, to cause an increase in size in a minority of patients. Complications are treated with bromocryptine. Enlargement of GH-secreting tumors with acromegaly may respond to bromocryptine and possibly to octreotide. Pituitary tumors causing Cushing's syndrome may need removal if major complications develop. Hypopituitarism during pregnancy may be the result of lymphocytic hypophysitis or antepartum pituitary necrosis, and in the postpartum period may be because of postpartum hemorrhage and pituitary necrosis. These abnormalities need prompt recognition and hormonal replacement therapy with neurosurgical decompression to avoid serious morbidity and mortality. Posterior pituitary problems in pregnancy usually manifest by diabetes insipidus, with a pregnancy-specific variety resulting from excessive degradation of AVP by placental vasopressinase. The condition is treated with an analogue dDAVP, which is resistant to vasopressinase.
妊娠会伴随一些形态学和生理学变化，如催乳细胞增多、催乳素分泌增加，以及促性腺激素和生长激素减少。激素环境可影响催乳素瘤患者，尤其是大腺瘤患者，少数患者的肿瘤会增大。并发症可用溴隐亭治疗。肢端肥大症患者分泌生长激素的肿瘤增大可能对溴隐亭有反应，也可能对奥曲肽有反应。如果出现严重并发症，导致库欣综合征的垂体肿瘤可能需要切除。孕期垂体功能减退可能是淋巴细胞性垂体炎或产前垂体坏死的结果，产后垂体功能减退可能是产后出血和垂体坏死所致。这些异常情况需要及时识别，并进行激素替代治疗及神经外科减压，以避免严重的发病和死亡。孕期垂体后叶问题通常表现为尿崩症，有一种与妊娠相关的类型是由于胎盘血管加压素酶过度降解抗利尿激素（AVP）所致。这种情况可用对血管加压素酶有抗性的类似物去氨加压素（dDAVP）治疗。
