Pituitary microadenomas: diagnostic and therapeutic trends.

It can be categorically stated that any clinician who treats medical problems in women during the reproductive or the peripubertal years must be aware of risks of pituitary adenomas and available diagnostic and therapeutic modalities. Pituitary adenomas may present during the pubertal period in association with delayed or incomplete development of secondary sexual characteristics. Primary or secondary amenorrhea may be the most obvious clinical abnormality. Patients with menstrual irregularity or secondary amenorrhea are at risk of hyperprolactinemia and pituitary adenomas. At present, the exact risk is unknown. Patients who are at greatest risk appear to be those with hyperprolactinemia, galactorrhea, and amenorrhea. Patients with apparent functional hyperprolactinemia may be harboring small pituitary adenomas. This possibility should be considered when using bromocriptine therapy. Pregnancy in patients with pituitary adenomas may be either normal or complicated by pituitary tumor enlargement, hemorrhage, or visual disturbances. There is no known accurate predictor of individual risk. Patients conceiving spontaneously or after induced ovulation should be followed closely to detect and treat possible pituitary or visual complications, or both, as rapidly as possible, thereby avoiding serious permanent sequelae.