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Neurochirurgie
Vol 46, N° 2  - mai 2000
p. 88
Doi : JNG-05-2000-46-2-0028-3770-101019-ART58
Table ronde Neurochirurgie et grossesse

Pathologie hypophysaire et grossesse
 

M. Jan [1], C. Destrieux [1]
[1] Service de Neurochirurgie, CHU Bretonneau, 37044 Tours Cedex 01.

Abstract
Pituitary disorders in pregnancy.

During pregnancy there is a normal increase in the volume of the anterior pituitary as demonstrated by MRI and hormone secretions which increase (PRL) or decrease (FSH, LH). During pregnancy pituitary adenomas, especially prolactinomas, may evolve as in non-pregnant women (microadenomas) or differently (macroadenomas). In 35 % of cases macroprolactinomas worsen during pregnancy making their medico-surgical management mandatory prior to pregnancy. Inversely, pregnancy occurring in a subject with a microprolactinoma never induces severe local complications so such tumors may be managed surgically or medically.

Surgery should be performed for acromegaly or Cushing's disease before or early in pregnancy. Subacute pituitary apoplexy (intratumoral hemorrhage) occurs in about 10 to 15 % of adenomas but, generally speaking, clinical symptoms remain mild in prenant women.

Lymphocytic hypophysitis occurs at the end of pregnancy, or during the post-partum period. The association of complete pan-hypopituitarism and hypersignal on MRI examination may mimic hypophyseal apoplexy and could lead to and inappropriate surgical procedure.

Abstract

Pendant la grossesse, les modifications de l'hypophyse normale sont marquées essentiellement par son augmentation de volume, bien étudiée en IRM et par l'élévation des sécrétions normales (PRL) ou leur abaissement (FSH, LH).

Les adénomes hypophysaires et surtout les prolactinomes les plus fréquents auront un comportement parfois identique (microadénomes), parfois différent (macroadénomes) à ceux rencontrés chez des femmes non gestantes. Les possibilités d'aggravation peuvent atteindre 35 % des macroprolactinomes en cours de grossesse, rendant obligatoire leur prise en charge médico-chirurgicale préalable. Les microprolactinomes pourront être traités médicalement ou chirurgicalement de préférence, mais les grossesses obtenues avec un microadénome en place n'ont jamais entraîné de complications graves à ce niveau. Devant une acromégalie ou une maladie de Cushing, il faut pratiquer l'exérèse de l'adénome avant d'envisager une grossesse.

L'apoplexie hypophysaire subaiguë (hémorragies) survient dans 10 à 15 % des adénomes, mais reste exceptionnelle dans ses manifestations dramatiques chez la femme enceinte.

Les hypophysites lymphocytaires se manifestent en fin de grossesse ou dans le post partum, se traduisant par un tableau de panhypopituitarisme conduisant parfois de façon erronée à une intervention chirurgicale devant des signes cliniques d'apoplexie hypophysaire et un hypersignal à l'IRM.

Keywords: pituitary gland. , prolactinoma. , hypophysitis. , pregnancy. , post-partum. , pituitary apoplexy.


Les autres adénomes hypophysaires  (+)




© 2000 Elsevier Masson SAS. Tous droits réservés.
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