Pituitary disorders during pregnancy

Hyperprolactinemia and Cushing's syndrome may interfere with fertility and need to be controlled to allow conception. Cushing's syndrome, acromegaly, and hyperthyroidism secondary to thyroid-stimulating hormone (TSH) hypersecretion may increase maternal morbidity and fetal morbidity and mortality. Removal of an adrenocorticotropin hormone-secreting tumor during pregnancy is warranted to reduce fetal loss, and medical control of hyperthyroidism is indicated. Pregnancy also may cause an increase in prolactin-secreting tumors, especially macroadenomas. In patients with hypopituitarism, thyroid hormone doses should be increased empirically because TSH levels cannot be used. Usually no increase in glucocorticoid dose is needed except to cover the stress of labor and delivery. Lymphocytic hypophysitis may occur with mass effects or hypopituitarism. Appropriate evaluation and hormone replacement are indicated in the acute and chronic forms of Sheehan's syndrome.