Surgical Management of Pituitary Adenoma During Pregnancy: A Short Series with Review of Literature

Background: Pituitary adenoma is infrequent during pregnancy. As surgery for pituitary adenoma is hazardous, further complicated by physiological changes brought by pregnancy. Mostly such cases were managed with medical therapy. As surgical adenoma decompression during pregnancy represent a therapeutic challenge for decompression without producing any further stress to pregnant women and teratogenic effect on foetus. So management during pregnancy is still debatable due to paucity of published literature. Aims: To analyze the outcome of surgery, who were operated during pregnancy for pituitary adenoma including effects of surgery and anaesthetic medications on developing foetus. Result: Authors are reporting two cases of pituitary adenoma, who presented during the pregnancy. First case presented during the third trimester and second in the second trimester of pregnancy with rapid deterioration of vision. Both patients underwent transsphenoidal decompression of pituitary adenoma. Pregnancy continued after surgery, and babies were delivered at term. During the follow-up period of the rest the pregnancy, growth of child was adequate without teratogenic effect. Conclusion: Our one case was operated safely through transsphenoidal approach during second trimester of pregnancy without any risk to fetus and another during third trimester. Uterine relaxant was continued in the postoperative period to prevent spontaneous abortion. Both cases were managed by trans-sphenoidal surgery. To the best of knowledge of authors, current report of two cases of pituitary adenoma associated with pregnancy is the first series of successful transsphenoidal decompression of pituitary adenoma during pregnancy. Pregnancy in both cases had good outcome. Patients with pituitary adenoma during pregnancy can safely be undergo surgical intervention, if medication therapy is either ineffective in controlling symptoms, visual and neurological deficits or contraindicated.