Management of a mixed ACTH- and prolactin-secreting pituitary adenoma during pregnancy

Mixed ACTH- and PRL-secreting pituitary adenomas, although extremely rare, do occur and may lead to both Cushing's syndrome and galactorrhea/oligo- or amenorrhea syndrome. Cabergoline therapy is an option in such cases and may decrease both PRL and ACTH levels; however, its efficacy in controlling Cushing's disease is limited. Preconception counseling is essential in women of childbearing age suffering from secreting pituitary tumors. Management of prolactinoma during pregnancy usually includes cessation of dopamine agonists and close follow-up to detect tumor growth, especially during the third trimester. Diagnosis of Cushing's syndrome during pregnancy is challenging due to the physiological activation of the hypothalamic-pituitary-adrenal axis. Cushing's syndrome may worsen during pregnancy and is associated with severe maternal and fetal complications. Early diagnosis and treatment are essential to improve fetomaternal outcomes. Transsphenoidal surgery performed during the second trimester is an effective and safe treatment for ACTH-secreting adenomas during pregnancy.