Matteo Zoli1,2, Federica Guaraldi3,4, Cesare Zoia5, Emanuele La Corte3, Sofia Asioli4,6, Daniele Bongetta7, Arianna Rustici8, Diego Mazzatenta3,4. 1. Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139, Bologna, Italy. matteo.zoli4@unibo.it. 2. Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy. matteo.zoli4@unibo.it. 3. Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139, Bologna, Italy. 4. Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy. 5. Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. 6. Unit of Anatomic Pathology 'M. Malpighi', Bellaria Hospital, Azienda USL Bologna, Bologna, Italy. 7. Neurosurgery Unit, ASST Fatebenefratelli Sacco, Milano, Italy. 8. Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy.
Abstract
INTRODUCTION: Sellar/parasellar tumors (SPTs) very rarely become symptomatic during pregnancy. No specific guidelines exist for their management, that is extremely challenging as mother and fetus health can be jeopardized. MATERIALS AND METHODS: Data of patients with SPTs becoming symptomatic during pregnancy treated at two Italian referral Centers were retrospectively collected. Systematic literature review was also performed. RESULTS: Our series consisted of 6 cases, 3 meningiomas, 1 ACTH-secreting adenoma, 1 pituicytoma and 1 craniopharyngioma. Mean age at presentation was 33.6 ± 6.0 years. Five patients complained of visual disturbances, associated with headache in one case, that occurred between gestation week (GW) 22 and 34. In 5 cases, pregnancy was uneventful with the delivery of a healthy baby between GW 33 and 35, followed by endoscopic surgical tumor exeresis (n = 4) or proton bean therapy (n = 1). Another patient presented with stigmata typical of Cushing's syndrome and rapidly worsening pre-eclampsia, that required pregnancy interruption and adenomectomy. Based on personal and literature cases, a practical algorithm was proposed to help clinicians dealing with these patients. CONCLUSIONS: SPTs becoming symptomatic in pregnancy deserve careful monitoring and multidisciplinary management. Overall, wait-and-see approach is suggested, reserving surgery to patients with rapidly progressive/life-threatening situations, significant risk of permanent neurological impairment or malignant lesions.
INTRODUCTION: Sellar/parasellar tumors (SPTs) very rarely become symptomatic during pregnancy. No specific guidelines exist for their management, that is extremely challenging as mother and fetus health can be jeopardized. MATERIALS AND METHODS: Data of patients with SPTs becoming symptomatic during pregnancy treated at two Italian referral Centers were retrospectively collected. Systematic literature review was also performed. RESULTS: Our series consisted of 6 cases, 3 meningiomas, 1 ACTH-secreting adenoma, 1 pituicytoma and 1 craniopharyngioma. Mean age at presentation was 33.6 ± 6.0 years. Five patients complained of visual disturbances, associated with headache in one case, that occurred between gestation week (GW) 22 and 34. In 5 cases, pregnancy was uneventful with the delivery of a healthy baby between GW 33 and 35, followed by endoscopic surgical tumor exeresis (n = 4) or proton bean therapy (n = 1). Another patient presented with stigmata typical of Cushing's syndrome and rapidly worsening pre-eclampsia, that required pregnancy interruption and adenomectomy. Based on personal and literature cases, a practical algorithm was proposed to help clinicians dealing with these patients. CONCLUSIONS: SPTs becoming symptomatic in pregnancy deserve careful monitoring and multidisciplinary management. Overall, wait-and-see approach is suggested, reserving surgery to patients with rapidly progressive/life-threatening situations, significant risk of permanent neurological impairment or malignant lesions.
Authors: C Villa; A Vasiljevic; M L Jaffrain-Rea; O Ansorge; S Asioli; V Barresi; L Chinezu; M P Gardiman; A Lania; A M Lapshina; L Poliani; L Reiniger; A Righi; W Saeger; J Soukup; M Theodoropoulou; S Uccella; J Trouillas; F Roncaroli Journal: Virchows Arch Date: 2019-10-02 Impact factor: 4.064
Authors: Shlomo Melmed; Felipe F Casanueva; Andrew R Hoffman; David L Kleinberg; Victor M Montori; Janet A Schlechte; John A H Wass Journal: J Clin Endocrinol Metab Date: 2011-02 Impact factor: 5.958
Authors: Renato Cozzi; Maria Rosaria Ambrosio; Roberto Attanasio; Claudia Battista; Alessandro Bozzao; Marco Caputo; Enrica Ciccarelli; Laura De Marinis; Ernesto De Menis; Marco Faustini Fustini; Franco Grimaldi; Andrea Lania; Giovanni Lasio; Francesco Logoluso; Marco Losa; Pietro Maffei; Davide Milani; Maurizio Poggi; Michele Zini; Laurence Katznelson; Anton Luger; Catalina Poiana Journal: Eur J Endocrinol Date: 2022-02-03 Impact factor: 6.664