Jia XY, Guo XP, Yao Y, Deng K, Lian W, Xing B. Surgical management of pituitary adenoma during pregnancy. World J Clin Cases 2023; 11(12): 2694-2707 [PMID: 37214566 DOI: 10.12998/wjcc.v11.i12.2694]
Corresponding Author of This Article
Bing Xing, MD, Neurosurgeon, Professor, Department of Neurosurgery, Key Laboratory of Endocrinology of Ministry of Health, China Pituitary Adenoma Specialist Council, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, No. 1 Shufuyuan, Dongcheng District, Beijing 100730, China. xingbingemail@aliyun.com
Research Domain of This Article
Clinical Neurology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Xin-Yu Jia, Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
Xin-Yu Jia, Xiao-Peng Guo, Yong Yao, Kan Deng, Wei Lian, Bing Xing, Department of Neurosurgery, Key Laboratory of Endocrinology of Ministry of Health, China Pituitary Adenoma Specialist Council, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
Xin-Yu Jia, Department of Plastic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Xiao-Peng Guo, Yong Yao, Kan Deng, Wei Lian, Bing Xing, Department of Neurosurgery, Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
Author contributions: All authors contributed to the study conception and design; Jia XY, Guo XP, Yao Y, Deng K, Lian W and Xing B contributed to material preparation, data collection and analysis; Jia XY wrote the first draft of the manuscript; all authors contributed to critical revision of the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: The Institutional Review Board of Peking Union Medical College Hospital provided approval for this study (IRB: I-23PJ338).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment. Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bing Xing, MD, Neurosurgeon, Professor, Department of Neurosurgery, Key Laboratory of Endocrinology of Ministry of Health, China Pituitary Adenoma Specialist Council, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, No. 1 Shufuyuan, Dongcheng District, Beijing 100730, China. xingbingemail@aliyun.com
Received: November 22, 2022 Peer-review started: November 22, 2022 First decision: February 14, 2023 Revised: March 1, 2023 Accepted: March 24, 2023 Article in press: March 24, 2023 Published online: April 26, 2023 Processing time: 154 Days and 20.1 Hours
Abstract
BACKGROUND
Although conservative treatment is typically recommended for pregnant patients with pituitary adenoma (PA), surgical treatment is occasionally necessary for those with acute symptoms. Currently, surgical interventions utilized among these patients is poorly studied.
AIM
To evaluate the surgical indications, timing, perioperative precautions and postoperative complications of PAs during pregnancy and to provide comprehensive guidance.
METHODS
Six patients with PAs who underwent surgical treatment during pregnancy at Peking Union Medical College Hospital between January 1990 and June 2021 were recruited for this study. Another 35 pregnant patients who were profiled in the literature were included in our analysis.
RESULTS
The 41 enrolled patients had acute symptoms including visual field defects, severe headaches or vision loss that required emergency pituitary surgeries. PA apoplexies were found in 23 patients. The majority of patients (55.9%) underwent surgery in the second trimester of pregnancy. A multidisciplinary team was involved in patient care from the preoperative period through the postpartum period. With the exception of 1 patient who underwent an induced abortion and 1 fetus that died due to a nuchal cord, 39 patients delivered successfully. Among them, 37 fetuses were healthy until the most recent follow-up.
CONCLUSION
PA surgery during pregnancy is effective and safe during the second and third trimesters. Pregnant patients requiring emergency PA surgery require multidisciplinary evaluation and healthcare management.
Core Tip: Although clinicians generally recommend conservative treatment for patients with pituitary adenomas (PAs), surgical treatment is occasionally necessary. Currently, surgical interventions utilized among these patients is poorly studied. This study investigated the surgical interventions utilized for patients with PAs occurring during pregnancy. We found that in the second and third trimesters transsphenoidal PA surgery is a safe and effective approach for emergency conditions arising during pregnancy and may be conducted after a multidisciplinary team evaluation. These strategies may open up new avenues for the treatment of PAs during pregnancy in the future.
