Neuroendocrinology and Pituitary

MON-091 - Maternal and Fetal Outcomes of Pituitary Adenomas and Cushing'S Syndrome during Pregnancy: Systematic Reviews and Meta-Analyses

Monday, June 15, 2026

9:00 AM - 2:00 PM CT

Location: ENDOExpo; Poster Floor

Co-Author(s)

DB

Diego Barata Bandeira, MD, PhD

São Paulo State University, Medical School
Botucatu, Brazil
Gd

Gabriela de Abreu Santos, student

São Paulo State University, Medical School
Botucatu, Brazil
LS

Letícia Santana Alves, MD

São Paulo State University, Medical School
Botucatu, Brazil
TO

Thaina Oliveira Felicio Olivatti, MD

São Paulo State University, Medical School
Botucatu, Brazil
MS

Milena Santos Ferreira, student

São Paulo State University, Medical School
Botucatu, Brazil
AG

Andrea Glezer, MD, PhD

Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of Sao Paulo Medical School
São Paulo, Brazil
MM

Marcio Carlos Machado, M.D.

University of Sao Paulo Medical School
Sao Paulo, Brazil
CB

Cesar L. Boguszewski, MD, PhD

Endocrine Division (SEMPR), University Hospital, Federal University of Paraná
Curitiba, Brazil

Abstract Poster Presenter(s)

Vd

Vania dos Santos Nunes-Nogueira, MD, PhD

Department of Internal Medicine, São Paulo State University (UNESP), Medical School
Botucatu, São Paulo, United States

Introduction: Pregnancy in women with pituitary adenomas raises concerns regarding the interaction between pituitary disease and the physiological changes of gestation.

Objective: To evaluate the natural course and maternal–fetal outcomes of pituitary adenomas and Cushing’s syndrome (CS) during pregnancy.

Methods: Five systematic reviews were conducted according to JBI methodology for etiology and risk, including observational studies of pregnant women diagnosed with pituitary adenomas or CS. Outcomes included tumor increase, hormonal control, maternal complications (diabetes, hypertension, preterm birth, spontaneous abortion) and neonatal outcomes (perinatal mortality, low birth weight, congenital malformations, small for gestational age). Searches were performed in Embase, MEDLINE, CENTRAL, and LILACS. Two reviewers independently selected studies, extracted data, and assessed risk of bias. Meta-analyses were performed using STATA 18.

Results: For acromegaly, 19 studies including 273 pregnancies showed clinical disease control in 62% and tumor growth in 9%; gestational diabetes, hypertension, and preterm birth occurred in 9%( 95% CI, 5–18%), 6% (95% CI, 3–15%), and 9% (95% CI, 5–13%), respectively. For prolactinoma, 52 studies (2,544 pregnancies) reported spontaneous abortion in 10% (95% CI, 8-12), preterm birth in 3% (95% CI, 2-5), congenital malformations in 2% (95% CI, 1-4), perinatal mortality in 2% (95% CI, 1-2), and low birth weight in 6% (95% CI, 3-9). The proportion of symptomatic tumor growth during pregnancy was 4% (95% CI, 2-8), 4% for visual impairment (95% CI, 2-7), dopamine agonists were used at conception in 97% of cases. For CS, 22 studies (380 pregnancies) showed higher complication proportions, including preterm birth (37%; 95% CI, 24–52%), hypertension (39%; 95% CI, 23–58%), diabetes (23%; 95% CI, 13–39%), perinatal mortality (7%; 95% CI, 3–13%), and low birth weight (27%;95% CI, 15–43%). For non-functioning pituitary adenomas, 5 studies (36 pregnancies) reported tumor growth in 36%, visual impairment in 20%, and apoplexy in 15%. Only 12 pregnancies with TSH-secreting adenomas were identified. One maternal death occurred, in a patient with CS. A meta-analysis of four studies revealed that uncontrolled hypercortisolism was associated with higher odds of hypertension, diabetes, and preterm birth.

Conclusion: Except for CS, maternal and fetal outcomes in pregnancies complicated by pituitary disorders were generally comparable to the general obstetric population. Poor outcomes in CS were likely related to uncontrolled hypercortisolism at conception and during pregnancy. PROSPERO registrations: CRD42021283757, CRD42020151416, CRD42024597682, CRD42024598697, CRD420251065843.

Funding: Research Productivity Grants (CNPq, Grant 309788/2022-6), Foundation São Paulo Research (FAPESP , Grant 2024/07690-7).

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*