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

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.

Chinese abstract

介绍：妊娠期的垂体障碍并不常见。密切随访是降低与妊娠期生理变化和治疗副作用造成母儿相关风险的方法。

材料和方法：我们报告1例21岁患有促甲状腺激素释放激素的垂体大腺瘤和抗甲状腺抗体阳性的女性。她得到的初始治疗是经蝶骨垂体手术。其在术后17个月复发, 遂开始服用生长抑素类似物治疗, 该药可快速控制甲状腺功能亢进。11个月后, 仍在接受奥曲肽治疗期间患者妊娠, 遂停止药物治疗。随后其妊娠期和分娩期均很顺利, 并分娩一健康足月新生儿。在产后15周患者出现产后甲状腺炎。产后28个月后, 其无再用药而甲状腺功能正常。

结论：目前文献报道的有良性结局的病例共有四例, 其中包括本文报道的新增病例, 建议妊娠不应成为促甲状腺素瘤女性的绝对禁忌。我们强调奥曲肽控制甲状腺功能亢进的效果以及当发现患者妊娠时应停止使用该药。在本例报告中, 奥曲肽停药后经过密切观察, 获得了良好结局。

Keywords:

• Pituitary tumors
• pregnancy
• thyrotropinoma

Declaration of interest

The authors declare that they have no conflicts of interest.