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∆ Pregnancy
Wednesday, July 28, 2010
12:05 PM Interesting: PARS INTERMEDIA
- structure is a very small, not even bone,
- only few epitherlia lined cysts
PITUITARY GLAND CHANGES and related DISEASES IN PREGNANCY - some adults don’t have it
- Active in fetus/pregnancy
Pituitary Gland Growth ○ Produce MSH hormone (melanocyte stimulating
Massive growth first 2 decades hormone)
After, declines in mass throughout rest of life ○ Increase fetus hearing
Women with G1+ status: larger and upward convexity ○ Darkening of skin color in women
- Postpartum shuts off
19th century autopsy: first time showed enlargement in pregnancy
PROLACTINOMAS - Enlargement of pit. expected - does not mean adenmatous pit enlargment
- Prolactinomas that enlarge during pregnancy are uncommon
- Suggestive growth
- Headahce
Prolactin = PRL - Visual field changes
PRL secreting lactotrophs make up 20% pit. Cells in men/nulliparous women - Gestational Diabetes insipidus (enzyme from placental destroys ADH)
Lactotroph Hyperplasia: End of pregnancy = 50% pituitary cells - Prolactinomas clinical risk
Reason: from inhibition of somatrotrophs from GH, and effect of increasing Microplactinoma: 1.3% risk for enlargment
estrogen Macroplactinoma: 23.2% when untreated (2.8% with treatment)
Number lactotrophs decline quickly after deliver --> especiially if no lactation - Common treatment: BROMOCRIPTINE
Recommended for women that become symptomatic (headache, visual field changes)
But still high levels 11 months postpartum - never complete regression (25% sat. in Preferable treatment over surgery
multiparous women) Transsphenoidal surgery if no response to drug therapy
APPROACH:
Prolactin and Breasts □ Use bromcoriptine to allow ovulation
- Hig h levesls of estrogen --> increase circulating prolactin □ Discontunie at beginning of pregnancy
- Prolactin prepares breasts for lactation □ Start again if evidence of tumor growth
1st tri: 20-40 ng/mL (ng=nanogram)
2nd tri: 50-150 ng/mL - BENEFITS
3rd tri: 100-400 ng/ML Often improvement/resolution of hyperprolactinoma after pregnancy
□ Fetal levels mimic mom: 80-500 ng/ML 27-29% resolution
□ INTERESTING: reason for neonatal milk/galactorrhea following birth Mechanism unknown: speculation regarding vascualr ischemia and necrosis in tumor??
Acromegaly in pregnancy
- BENEFITS:
○ Pregnancy lead to improvement of acromegaly in 3 pregnancies with uncontrolled
acromegalic women (blocking effects of estrogen on IGF1 producing in liver)
(hypopituitarism) Sheehan i.
ii.
DIAGNOSIS
Typical obstetric history of severe postpartum vag bleeding
Severe hypotnesions or shock for which blood traunsfuion/fluid replacement necessary
Syndrome iii.
iv.
v.
Failure of postpartum lactation
Failure to resume regular menses after delivery
Varyging degrees of ant pituitary failure/partial panhypopituitarism
vi. Empty sella on CT scan/mri
Spontaneous resulotion reported after delivery for those diagnosed during pregnancy