Management of sellar and parasellar tumors becoming symptomatic during pregnancy: a practical algorithm based on multi-c
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Management of sellar and parasellar tumors becoming symptomatic during pregnancy: a practical algorithm based on multi‑center experience and systematic literature review Matteo Zoli1,2 · Federica Guaraldi1,2 · Cesare Zoia3 · Emanuele La Corte1 · Sofia Asioli2,4 · Daniele Bongetta5 · Arianna Rustici6 · Diego Mazzatenta1,2 Accepted: 3 November 2020 © The Author(s) 2020
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. Keywords Pituitary tumors · Pituitary adenoma · Meningioma · Pregnancy · Management · Outcome
Introduction Matteo Zoli and Federica Guaraldi have equally contributed to the manuscript. * Matteo Zoli [email protected] 1
Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139 Bologna, Italy
2
Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
3
Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
4
Unit of Anatomic Pathology ‘M. Malpighi’, Bellaria Hospital, Azienda USL Bologna, Bologna, Italy
5
Neurosurgery Unit, ASST Fatebenefratelli Sacco, Milano, Italy
6
Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
Sellar/parasellar tumors (SPTs) can enlarge during pregnancy as a consequence of multiple mechanisms [1–5]. Pituitary volume physiologically enlarges because of estrogen-stimulated hypertrophy and hyperplasia of lactotroph cells, the last supporting the greater propensity of prolactinomas and pluri-hormonal adenomas to increase in size during pregnancy. In m
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