Annals of Internal Medicine Visual Loss in Pregnant Women with Pituitary Adenomas

• Objective: To investigate the potential risk for devel-oping visual loss during single or multiple pregnancies in women with pituitary adenomas. • Design: Cohort study. • Setting: Referral center of a neuro-ophthalmology service. • Patients: 65 consecutive women with pituitary ade-nomas who had not been previously treated with sur-gery or radiation were monitored during 111 pregnan-cies. Sixty had increased levels of serum prolactin or growth hormone and 5 did not. • Main Outcome Measures: Visual field or acuity loss was compared with the baseline size of the adenoma measured on the coronal view of the computed tomo-graphic or magnetic resonance image. • Results: Computed tomography or magnetic reso-nance imaging showed a definitive tumor (>0.3 cm, vertical height) in 57 patients, 8 of whom had macroad-enomas (> 1.1 cm). Visual field loss occurred in 6 of 8 primiparous patients, all with adenomas greater than 1.1 cm (range, 1.2 to 2.5 cm). None of the 57 patients (95 % CI, 0 % to 6.3%) with a microadenoma or pre-sumed microadenoma of 1 cm or smaller developed visual loss after as many as four full-term pregnancies. • Conclusions: The risk for developing visual loss during single or multiple pregnancies in patients with microadenomas was small. Six of eight pregnant women with macroadenomas, however, developed vi-sual field loss during pregnancy