Management of a pregnant woman with thyrotropinoma: a case report and review of the literature

Gynecol Endocrinol. 2017 Mar;33(3):188-192. doi: 10.1080/09513590.2016.1260110. Epub 2016 Dec 2.

Abstract

Introduction: Pituitary disorders during pregnancy are uncommon. The approach should include a close follow-up in order to reduce maternal and fetal risks associated with physiological changes during pregnancy or treatment side effects.

Materials and methods: We report a 21-year-old woman with a thyroid-stimulating hormone-secreting pituitary macroadenoma and positive antithyroid antibodies. She was initially treated using transsphenoidal pituitary surgery. The patient relapsed 17-month post-surgery. Somatostatin analog therapy was started which rapidly controlled the hyperthyroidism. Eleven months later, while receiving octreotide, the patient reported to be pregnant and the medication was stopped. Gestation and delivery went well with a healthy full-term newborn. The patient developed a postpartum thyroiditis 15 weeks after giving birth. Twenty-eight months postpartum the patient remains euthyroid without medication.

Conclusions: The overall positive outcomes of the four cases reported in literature, including this new case, suggest that pregnancy should not be absolutely contraindicated in women with thyrotropinomas. We emphasize the effectiveness of octreotide to control hyperthyroidism, as well as stopping medication when a patient is found to be pregnant. In our case, close observation following octreotide cessation had a positive outcome.

Keywords: Pituitary tumors; pregnancy; thyrotropinoma.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adenoma / drug therapy*
  • Adenoma / metabolism
  • Adenoma / physiopathology
  • Adenoma / surgery
  • Adult
  • Antineoplastic Agents, Hormonal / administration & dosage
  • Antineoplastic Agents, Hormonal / adverse effects
  • Antineoplastic Agents, Hormonal / therapeutic use
  • Combined Modality Therapy / adverse effects
  • Drug Monitoring
  • Female
  • Humans
  • Hyperthyroidism / etiology
  • Hyperthyroidism / prevention & control
  • Neoplasm Recurrence, Local / drug therapy
  • Neoplasm Recurrence, Local / physiopathology
  • Neoplasm, Residual
  • Octreotide / administration & dosage
  • Octreotide / adverse effects
  • Octreotide / therapeutic use
  • Organ Sparing Treatments / adverse effects
  • Pituitary Gland / drug effects*
  • Pituitary Gland / metabolism
  • Pituitary Gland / surgery
  • Pituitary Neoplasms / drug therapy*
  • Pituitary Neoplasms / metabolism
  • Pituitary Neoplasms / physiopathology
  • Pituitary Neoplasms / surgery
  • Pregnancy
  • Pregnancy Complications, Neoplastic / drug therapy*
  • Pregnancy Complications, Neoplastic / physiopathology
  • Term Birth
  • Thyrotropin / metabolism
  • Treatment Outcome
  • Young Adult

Substances

  • Antineoplastic Agents, Hormonal
  • Thyrotropin
  • Octreotide