serografias

Documento descargado de http://www.elsevier.es el 12/04/2010. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato.

03 DOC TRAB 2439(29-43).qxp

20/2/07

13:04

Página 29

226.684

Documentos de los
grupos de trabajo
CLINICAL PRACTICE GUIDELINE FOR
HYPOTALAMIC-PITUITARY
DISTURBANCES IN PREGNANCY AND
THE POSTPARTUM PERIOD
Duringpregnancy, the body undergoes a
major adaptation process as a result of the
interaction between mother, placenta and
fetus. Major anatomical and histological
changes are produced in the pituitary, with
an increase of up to 40% in the size of the
gland.
There are wide variations in the function of
the hypothalamus-pituitary-thyroid axis
that effect iodine balance, the overall
activity ofthe gland, as well as transport of
thyroid hormones in plasma and
peripheral metabolism of thyroid
hormones. The incidence of goiter and
thyroid nodules increases throughout
pregnancy. The management of
differentiated thyroid carcinoma should be
individually tailored according to tumoral
type and pregnancy stage. Given the
effects of hypothyroidism on fetal
development, both thediagnosis and
appropriate therapeutic management of
thyroid hypofunction are essential.
The most important modification to the
hypothalamus-pituitary-adrenal axis during
pregnancy is the rise in serum cortisol
levels due to an increase in cortisolbinding proteins. Although Cushing’s
syndrome during pregnancy is infrequent,
both diagnosis and treatment of this
disorder are especiallydifficult. Adrenal
insufficiency during pregnancy does not
substantially differ from that occurring
outside pregnancy. However, postpartum
pituitary necrosis (Sheehan’s syndrome) is
a well-known complication that occurs
after delivery and, together with
lymphocytic hypophysitis, constitutes the
most frequent cause of adrenal
insufficiency.
The management of prolactinoma during
pregnancyrequires suppression of
dopaminergic agonists and their
reintroduction if there is tumoral growth.
Notable among the neuropituitary
disorders that can occur throughout
pregnancy is diabetes insipidus, which
occurs as a consequence of increased
vasopressinase activity.
Key words: Hypothalamic-pituitary axis. Pregnancy. Postpartum period. Hypothyroidism. Hyperthyroidism. Secondary adrenalinsufficiency.
Hypercortisolism. Acromegaly. Prolactinoma. Diabetes insipidus.

Guía clínica de las modificaciones
hipotalamohipofisarias en el
embarazo y en el período posparto
IRENE HALPERIN RABINOVICH, GABRIEL OBIOLS ALFONSO,
ALFONSO SOTO MORENO, ELENA TORRES VELA, FREDERIC
TORTOSA HENZI, MIGUEL CATALÀ BAUSET, ALBERTO GILSANZ
PERAL, JUAN GIRBÉS BORRÀS, BASILIO MORENO ESTEBAN,
ANTONIO PICÓALFONSO, CARLOS DEL POZO PICÓ, ANA
ZUGASTI MURILLO, TOMÁS LUCAS MORANTE, CONCHA
PÁRAMO FERNÁNDEZ, CÉSAR VARELA DA SOUSA Y CARLES
VILLABONA ARTERO

Grupo de Trabajo de Neuroendocrinología. Sociedad Española
de Endocrinología y Nutrición.
Durante el embarazo se producen importantes cambios adaptativos como
consecuencia de la relación entre la madre, la placenta y el feto. En la
hipófisisse producen importantes cambios anatómicos e histológicos con
un aumento del volumen de la glándula de hasta un 40%.
Se producen grandes variaciones en la función del eje
hipotalamohipofisotiroideo, que afectan al balance de yodo, la actividad
general de la glándula, y el transporte de las hormonas tiroideas en el
plasma y en el metabolismo periférico de éstas. La incidencia de bocio ynódulos tiroideos aumenta durante el embarazo. El manejo del carcinoma
diferenciado de tiroides deberá individualizarse en función del tipo de
tumor y el tiempo de embarazo. Dadas las repercusiones que el
hipotiroidismo tiene en el desarrollo fetal, es primordial tanto el
diagnóstico como el correcto manejo terapéutico de la hipofunción
tiroidea.
La modificación más importante del eje...