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Management of a mixed ACTH- and prolactin-secreting pituitary adenoma during pregnancy
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DOI：10.1530/EDM-24-0094.png)
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Abstract
En 中文
The diagnosis and management of Cushing's disease (CD) during pregnancy are challenging. Only a few cases of mixed pituitary adenomas secreting prolactin and ACTH have been reported, and none during pregnancy. We report the case of a 30-year-old woman who presented with galactorrhea, weight gain, hypertension, prediabetes, dorsal fat pad, and abdominal striae. Initial biochemical investigations revealed hyperprolactinemia with increased ACTH but no biochemical signs of hypercortisolism. Pituitary MRI showed a 10 mm pituitary adenoma, which was first considered a prolactinoma potentially co-secreting ACTH. Surgery was indicated, but the patient did not undergo treatment immediately due to lack of health insurance. Cabergoline monotherapy was initiated, with close follow-up advised until regularization of social status in Belgium. The patient was then lost to follow-up and presented 15 months later because of an early pregnancy with treatment-resistant hypertension. Biochemical evaluation during the first trimester led to the suspicion of ACTH-dependent cortisol excess and showed hyperprolactinemia despite ongoing cabergoline treatment. She underwent transsphenoidal surgery at 16 weeks of pregnancy, and pathological examination showed a single adenoma with two different cell components staining for PRL/PIT1 and ACTH/TPIT, respectively. Surgery was successful, the patient developed corticotrope insufficiency, and was able to stop antihypertensive drugs. Because of failed induction of labor (for gestational insulin-requiring diabetes), she underwent cesarean section at 39 weeks of pregnancy and gave birth to a healthy boy with no maternal or neonatal complications. Adrenal insufficiency recovered 12 months after surgery. Genetic testing for MEN1 and AIP was negative.
Keywords:
pituitary
reproduction
rare diseases/syndromes
neuroendocrinology
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