Dual diagnostic complexity in ART: pituitary microadenoma and heterotopic pregnancy - a case-based insight

Pituitary microadenomas are benign adenohypophyseal tumors most commonly related to hormonal dysregulation, possibly affecting fertility and reproductive function. This case report presents a 24-year-old female with a pre-existing preclinical diagnosis of pituitary microadenoma presenting to assisted reproductive treatment for subfertility. In spite of regular menstrual cycles and lack of any of the features of hyperprolactinemia at treatment, her clinical history warranted meticulous hormonal assessment and customized stimulation protocol. After controlled ovarian stimulation, ICSI, and frozen embryo transfer of two blastocysts, she got pregnant. To her astonishment, she was diagnosed with a heterotopic pregnancy, as evidenced by the presence of intrauterine and tubal gestation. This case points towards the intricate interplay between pituitary pathology and ART outcome. It emphasizes the need for individualized fertility management in patients with pituitary disease, who could have atypical or unpredictable responses to stimulation and implantation. The successful diagnosis and management of this uncommon dual-gestation event emphasize the caution required in the evaluation and multidisciplinary management in ART cycles with underlying endocrine pathology.