| 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
