Medical and Surgical Approaches for a Non-functioning Pituitary Adenoma During Pregnancy

Abstract

Non-functioning pituitary adenomas (NFPA) are most commonly found in post-menopausal women and men above the age of 50. They are mainly revealed by a tumor syndrome. The incidence of symptomatic NFPA during pregnancy is rare, with only nine documented cases in the literature. The patient was 39 years old with no previous medical or surgical history and was 17 weeks pregnant. A large pituitary macroadenoma measuring 17 x 18 x 19 mm was discovered radiologically in the presence of a pituitary tumor syndrome. Clinical examination revealed no signs of hormone deficiency or hypersecretion. A corticotropic and thyrotropic deficit was ruled out following a hormonal workup. Ophthalmological examination revealed reduced visual acuity and bilateral visual field damage. Treatment with cabergoline at a dose of 3 mg/week was initiated following written consent from the patient. The patient underwent vaginal delivery of a healthy newborn at term. Hormonal assessment at three months postpartum definitively ruled out hormonal hypersecretion. She underwent transsphenoidal surgery, with a histological examination of the resection specimen revealing a pituitary adenoma binding adrenocorticotrophic hormone (ACTH), prolactin (PRL), and growth hormone (GH). The postoperative evaluation revealed a corticotropic and somatotropic deficit with the presence of an adenomatous residue on imaging. Substitutive treatment was then initiated along with therapeutic education. To the best of our knowledge, this is the third case in which cabergoline treatment was initiated. Cabergoline treatment enabled the pregnancy to continue, improved the patient's clinical condition, stabilized the size of the adenoma, and prevented potential apoplexy.

Keywords: adenomas transsphenoidal surgery; cabergoline; non-functioning pituitary adenomas; pituitary adenomas; pregnancy.

Figure 1. Preoperative hypothalamic-pituitary MRI sagittal section

T1-weighted sagittal section of a 17 x 18 x 19 mm pituitary adenomatous lesion (red arrow).

Figure 2. Preoperative hypothalamic-pituitary MRI coronal section

T2-weighted coronal section of pituitary adenoma showing suprasellar extension with compression of the optic chiasm and inferior extension in contact with the right cavernous sinus, which includes the carotid artery (Knosp 2) as indicated by the red arrow.

Figure 3. Postoperative hypothalamic-pituitary MRI sagittal section

T2-weighted sagittal section of an 8 x 6 x 5 mm pituitary adenomatous residue with postoperative status and fat-filling material (red arrow).

Figure 4. Postoperative hypothalamic-pituitary MRI coronal section

T2-weighted coronal section of the pituitary adenomatous residue which comes into contact with the intracavernous portion of the right carotid sinus artery (red arrow).