Pituitary microadenoma with prolactin, corticotropic and thyreotropic deficiency: from infertility to pregnancy : About a case

Pituitary adenomas are benign tumors developed at the expense of different cellular populations of the pituitary gland. Within the pituitary gland, several cell populations may be involved, but the lactotropic cells remain the most frequently affected by this hyperplasia. For both sexes, the overall frequency of adenomas is 100 per million, of which 40% are prolactinomas. The stimulating effect of estrogens (combined oral contraceptives and pregnancy) on lactotropic cells has long been demonstrated, and in general, only large tumors (macroadenomas) have an evolving risk to be feared during pregnancy. The diagnosis rests on the one hand on the evidence of a hormonal hypersecretion of the cell population concerned as well as a hormonal deficiency of the other cell groups which can be compressed by the tumor. On the other hand, this diagnosis uses hypophyseal magnetic resonance imaging (MRI) to distinguish, according to their size, microadenomas (diameter less than 10 mm) from macroadenomas (diameter greater than 10 mm) pituitary. The risk of increasing the volume of the adenoma during pregnancy depends on the initial size of the tumor. This risk is evaluated at 2% for microadenoma and 15-35% for macroadenomas. However, the most severe complication during pregnancy remains paroxysmal acute growth or pituitary apoplexy by necrotic-haemorrhagic phenomena. The management is mainly based on prolactinoma on bromocryptin or cabergoline and sometimes surgery, urgently in the presence of a pituitary apoplexy or in the presence of an evolutionary macroadenoma.