Non-functioning pituitary adenomas and pregnancy: one-center experience and review of the literature

Abstract

The usual clinical presentation of non-functioning pituitary adenoma (NFPA) consists of symptoms of mass effect and hypopituitarism. NFPA is a rare condition in young women and an uncommon complication during pregnancy. We present the outcome of three patients with NFPA during pregnancy. Case 1: a 38-year-old woman was referred at 32^nd week of spontaneous pregnancy because of diagnosis of a pituitary macroadenoma discovered in the context of progressive visual loss. Hormonal deficiency and hypersecretion were ruled out. Prolactin levels were high as expected. She developed diplopia and severe headache despite the use of dopamine agonists and corticosteroids, so pregnancy was interrupted at 34^th week. After an uncomplicated delivery of a healthy newborn, transsphenoidal surgery was performed. The pathology was consistent with a gonadotroph adenoma. She recovered visual field, and remained with normal pituitary function. Postsurgical tumor remnant increased in size during the follow-up. Case 2: a 34-year-old woman was referred due to secondary amenorrhea and galactorrhea. A macroadenoma with suprasellar extension was discovered. Transsphenoidal surgery confirmed a gonadotroph adenoma. Two years after surgery she had a normal pregnancy. Six years after surgery a small tumor recurrence occurred. Case 3: a 23-year-old woman was referred due to a microincidental pituitary adenoma. Laboratory testing was normal. No findings on physical examination. A wait and see approach was decided. Two years after diagnosis, the patient got pregnant without complications. Image remained stable. This article may contribute new cases and provides an extensive review of NFPA during pregnancy.

Figure 1. Case 1 Pituitary MRI without gadolinium during pregnancy (A-B) and postpartum/postsurgery MRI with gadolinium (C-D-E): Coronal view of a large pituitary mass, hypointense on T1-weighted images (A), and hyperintense on T2-weighted images, with suprasellar extension and compression of the optic chiasm (B). Coronal view of a stable post-partum image after gadolinium-enhancement (C). Post-surgery pituitary MRI with gadolinium: coronal view of a small tumor remnant, T1-weighted images (D). Coronal T1-weighted image shows tumor re-expansion after 4 years of surgery (E).

Figure 2. Case 1 – Histologic pictures of the removed Gonadotroph adenoma: (A) Haematoxylin – eosin staining (x400), (B) Immunostaining for LH (x400), (C) Immunostaining for FSH (x400).

Figure 3. Case 2 – Pre-surgery pituitary MRI (A-B): Coronal view of a heterogeneous lesion with solid and cystic areas. T1 after gadolinium administration (A) and T2-weighted images (B) showed left cavernous sinus and suprasellar extension with compression of the optic chiasm. Post-surgery MRI (C-E): Coronal T1-weighted image showed partial empty sella and spontaneously hyperintense filling material. No visible tumor remnant (C) MRI performed after 6 months of a non-complicated pregnancy; the lesion remained stable (D). MRI six years after pregnancy. Contrast-enhanced coronal T1-weighted image shows a small tumor recurrence close to the left cavernous sinus (E).