Kupersmith and colleagues [1] reported that enlargement of pituitary adenomas with baseline heights of 1.2 cm or more in six patients during pregnancy resulted in visual field defects. Such enlargement is relatively common in women with prolactin-secreting macroadenomas [2]; however, this is the first report (that I am aware of) of enlargement of a growth hormone-secreting tumor in a patient with acromegaly or a "clinically nonfunctioning" tumor. These tumors did not secrete prolactin. These aspects deserve emphasis because they will influence clinicians with respect to prepregnancy counseling and in follow-up during pregnancy.

Readers should not think that 75% of women with pituitary adenomas 1.2 cm or more in height will develop visual field defects if they become pregnant. Considerable ascertainment bias exists in this study because all patients evaluated were initially seen by an ophthalmologist. Many patients with inferiorly directed tumors of this size do not have routine visual field examinations. However, this article does reemphasize the importance of careful follow-up of patients with pituitary adenomas during pregnancy, including visual field examinations if any degree of suprasellar extension is noted or if clinical symptoms warrant them.