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

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

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