Pituitary Disease in Pregnancy: Special Aspects of Diagnosis and Treatment?

Stephan Petersenn; Mirjam Christ-Crain; Michael Droste; Reinhard Finke; Jörg Flitsch; Ilonka Kreitschmann-Andermahr; Anton Luger; Jochen Schopohl; Günter Stalla

doi:10.1055/a-0794-7587

Geburtshilfe und Frauenheilkunde, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2019; 79(04): 365-374
DOI: 10.1055/a-0794-7587

GebFra Science

Review/Übersicht

Georg Thieme Verlag KG Stuttgart · New York

Hypophysenerkrankungen in der Schwangerschaft: Besonderheiten in der Diagnostik und Therapie?

Artikel in mehreren Sprachen: English | deutsch

Stephan Petersenn

¹ENDOC Praxis für Endokrinologie, Andrologie und medikamentöse Tumortherapie, Hamburg, Germany

,

Mirjam Christ-Crain

²Endokrinologie, Diabetologie & Metabolismus. Universitätsspital Basel, Basel, Switzerland

,

Michael Droste

³Endokrinologie, Diabetologie, Hormonanalytik. MEDICOVER MVZ, Oldenburg, Germany

,

Reinhard Finke

⁴Praxis an der Kaisereiche (üBAG), Berlin-Friedenau, Germany

,

Jörg Flitsch

⁵Klinik und Poliklinik für Neurochirurgie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany

,

Ilonka Kreitschmann-Andermahr

⁶Neurochirurgische Klinik, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany

,

Anton Luger

⁷Universitätsklinik für Innere Medizin III, Klinische Abteilung für Endokrinologie & Stoffwechsel, Medizinische Universität Wien, Wien, Austria

,

Jochen Schopohl

⁸Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany

,

Günter Stalla

⁸Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany

⁹Medicover Neuroendokrinologie, München, Germany

› Institutsangaben

Abstract

Zusammenfassung

Diagnose und Therapie von Hypophysenerkrankungen stellen in der Schwangerschaft eine besondere klinische Herausforderung dar. Nicht zuletzt ist die Datenlage zur Therapie von Patientinnen mit Hypophysenerkrankungen während der Schwangerschaft sehr eingeschränkt. Es wurde eine selektive Literaturrecherche nach Publikationen mit dem Ziel durchgeführt, die Evidenz zur Diagnostik und Therapie von Hypophysenerkrankungen in der Schwangerschaft zu beschreiben. Gesucht wurde in den Datenbanken PubMed/MEDLINE inkl. PubMed Central sowie mithilfe des Suchdienstes Livivo (ZBMED). Entsprechend der aktuellen Studienlage werden Empfehlungen zur Betreuung von Patientinnen mit hormoninaktiven und hormonaktiven Hypophysenadenomen (Prolaktinom, Akromegalie und Morbus Cushing), Hypophyseninsuffizienz sowie Hypophysenapoplex und Hypophysitis in der Schwangerschaft gegeben. Am besten ist sicherlich die Behandlung des Prolaktinoms etabliert, zurückzuführen auf die Inzidenz und speziellen Auswirkungen auf die Fertilität. Bei bestätigter Schwangerschaft sollte die dopaminagonistische Therapie des Prolaktinoms unterbrochen werden. Während Mikroprolaktinome nach Absetzen des Dopaminagonisten äußerst selten signifikant an Größe zunehmen, kann es bei Makroprolaktinomen zu symptomatischem Tumorwachstum kommen. In diesem Fall kann eine dopaminagonistische Therapie wieder aufgenommen werden, bei einem primär großen Tumor mit deutlich erhöhtem Wachstumsrisiko ggf. auch von Beginn an fortgeführt werden. Der Kinderwunsch vieler Paare kann trotz Hypophysenerkrankung eines Partners mit ärztlicher Unterstützung bei der Planung und Kontrolle der Schwangerschaft häufig erfüllt werden. Vor dem Hintergrund der Komplexität dieser Erkrankungen sollte die Betreuung schwangerer Patientinnen mit hypophysären Erkrankungen multidisziplinär in Zentren erfolgen, deren Schwerpunkt in der Diagnostik und Therapie von Hypophysenerkrankungen liegt.

Schlüsselwörter

Hypophysenerkrankungen - Hypophysentumor - Schwangerschaft - Fertilität - Diabetes insipidus

Volltext

Referenzen

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