Endo Serial Visual Field Pregnancy Macroadenoma

---
name: endo-serial-visual-field-pregnancy-macroadenoma
description: Recommends serial visual field testing during pregnancy for patients with acromegaly who harbor a macroadenoma to monitor for neurologic deterioration. Trigger when a pregnant acromegaly patient has a known pituitary macroadenoma.
---

# Suggest serial visual field testing in pregnant patients with macroadenomas

## STEP 1 — Gather Information
Confirm pregnancy, verify acromegaly diagnosis (elevated IGF-1 with lack of GH suppression to <1 µg/L after oral glucose load), document macroadenoma on pituitary MRI (size ≥10 mm), obtain baseline visual field testing and assess for headache or visual symptoms.  
**Action:** Proceed to assess need for serial visual field testing.

## STEP 2 — Rule In / Rule Out
Is a pituitary macroadenoma present on imaging?  
- **Yes:** Proceed to classification.  
- **No:** Do not recommend serial visual field testing; manage per routine prenatal care.  
**Action:** Branch based on macroadenoma presence.

## STEP 3 — Classify or Stratify
Assess for visual symptoms (headache, visual field defects) or known chiasmal abutment/compression on MRI.  
- **High risk:** Visual symptoms or chiasmal involvement.  
- **Moderate risk:** Asymptomatic macroadenoma without chiasmal signs.  
**Action:** Assign risk category.

## STEP 4 — Decide
- **High risk:** Perform visual field testing at baseline and each trimester (or every 3 months) throughout pregnancy.  
- **Moderate risk:** Perform baseline visual field testing and repeat each trimester or if new neurologic symptoms arise.  
**Action:** Implement scheduled visual field monitoring.

## Clinical Guardrails / Mimics / Pitfalls
Do not rely on GH or IGF-1 monitoring during pregnancy (per guideline 7.5) to assess tumor activity. Avoid delaying testing until symptomatic worsening; macroadenoma growth can be asymptomatic. Do not substitute CT for MRI when MRI is contraindicated without neurosurgical input. Remember to discontinue long-acting SRLs ≈2 months before conception per guideline 7.2.

## Concrete Clinical Example
A 32‑year‑old woman with known acromegaly and a 12 mm macroadenoma becomes pregnant; baseline visual field is normal. At 16 weeks she reports mild bilateral temporal blurring. Repeat testing shows emerging bitemporal hemianopia, prompting neurosurgical consultation for tumor debulking.

**Source:** Acromegaly: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2014, doi:10.1210/jc.2014-2700