Question: I had transsphenoidal surgery twice for a pituitary tumor. Now, testing is suspicious of another tumor in the lining membrane of the carotid artery. Gamma knife radiation is being discussed. I am a newlywed and would like to have a baby before any radiation or medication is used. What are my options? 

Answer: The major thing that needs to be determined is  whether biochemical testing actually shows recurrent Cushing’s or whether this is an MRI finding of unclear significance.

Pregnancy during active Cushing’s is rare. If this is truly recurrent Cushing’s, the risks of pregnancy in active Cushing’s to both the mother and the baby are substantial and a number of therapies can’t be used during pregnancy.

If Cushing’s is confirmed and trannshpenoidal surgery is not an option,  one option would be to have radiation done now and wait until the radiation works. Radiation can cause loss of normal pituitary hormones and if fertility is dependent on one of the hormones affected, ovulation induction may be required to accomplish pregnancy. Another option would be a bilateral adrenalectomy. This does not treat the pituitary tumor and life long replacement medications would be re-uired.  There is also a risk of Nelsons’s syndrome.

By Dr. Anne Klibanski, Massachusetts  General Hospital, Winter, 2014