Ese clinical practice guideline on functioning and nonfunctioning pituitary adenomas in pregnancy

Pregnancies are rare in women with pituitary adenomas, which ma y relate to hormone excess from secretory subtypes such as prolactinomas or corticotroph adenomas. Decrea sed fertility may also result from pituitary hormone deficiencies due to compression of the gland by large tumours an d/or surgical or radiation treatment of the lesion. Counselling premenopausal women with pituitary adenomas about t heir chance of conceiving spontaneously or with assisted reproductive technology, and the optimal pre-conc eption treatment, should start at the time of initial diagnosis. The normal physiological changes during pregnancy ne ed to be considered when interpreting endocrine tests in women with pituitary adenomas. Dose adjustments in hor mone substitution therapies may be needed across the trimesters. When medical therapy is used for pituitary horm one excess, consideration should be given to the known efficacy and safety data specific to pregnant women for each therapeutic option. In healthy women, pituitary gland size increases during pregnancy. Since some pituitary ade nomas also enlarge during pregnancy, there is a risk of visual impairment, especially in women with macroadenomas or tumours near the optic chiasm. Pituitary apoplexy represents a rare acute complication of adenomas requiring surv eillance, with surgical intervention needed in some cases. This guideline describes the choice and timing of diagno stic tests and treatments from the pre-conception stage until after delivery, taking into account adenoma size, locatio n and endocrine activity. In most cases, pregnant women with pituitary adenomas should be managed by a multidisciplinar y team in a centre specialised in the treatment of such tumours.