Multidisciplinary Management of Pituitary Neuroendocrine Tumors During Pregnancy: Institutional Report.

Abstract

Background: Management of pituitary neuroendocrine tumors (pitNETs) during pregnancy is challenging. Involvement of the multidisciplinary team (MDT) may benefit the collaborative decision-making. However, this aspect has not been well documented. We provided cases with pitNETs during pregnancy and summarized our experience on the MDT-guided management. Methods: We performed a retrospective study enrolling all pregnant patients with pitNETs treated at our institute between March 1995 and July 2024. Results: During the indexed period, 121 patients with pitNETs consulted our institute during pregnancy, with 111 of them being treated conservatively and 10 undergoing surgery due to progressive visual defect and other symptoms. The age of the included surgical cases was 33 years, and the gestational session at surgery ranged from 13 to 36 weeks (1 in the first trimester, 4 in the second, and 5 in the third). Of the resected tumors, six were nonfunctioning and the other four were functioning (1 lactotroph, 1 somatotroph, and 1 thyrotroph). All surgical cases received MDT-guided management by physicians from neurosurgery, endocrinology, ophthalmology, obstetrics, pediatrics, and anesthesiology, leading to gross total tumor resection, improved visual acuity, and successful delivery in all patients. Conclusion: MDT guided management is essential for pitNETs during pregnancy. Surgical tumor resection is necessary for patients whose symptoms deteriorate rapidly. Transsphenoidal operation under general anesthesia is safe for pregnant patients with pitNETs.