Chief of the Neuroendocrine Unit, Endocrinology and Metabolism Division, Hosputal das Clinicas, Univeristy of Sao Paulo Medical School Hospital das Clinicas University of Sao Paulo Medical School
Disease activity and maternal–fetal outcomes in pregnant women with cushing’s syndrome: a systematic review and meta‑analysis Diego Barata Bandeira, Gabriela de Abreu Santos, Andrea Glezer, Marcio Carlos Machado, Cesar Luiz Boguszewski, Vania dos Santos Nunes-Nogueira Reviews in Endocrine and Metabolic Disorders, 2026 Pregnancy in women with Cushing’s syndrome (CS) is uncommon due to the detrimental effects of hypercortisolism on fertility and is associated with an increased risk of maternal and fetal complications. This systematic review evaluated the natural course and maternal–fetal outcomes of CS during pregnancy. Searches were conducted in MEDLINE, EMBASE and LILACS for observational studies including at least three pregnant women with CS. Twenty-two studies comprising 381 pregnancies were included. Among 200 women with reported etiologies, 54% had Cushing’s disease, 24% had adrenal adenoma, and 11% had adrenal carcinoma. The overall rate of spontaneous miscarriage was 6% (21 studies, 245 pregnancies; 95% CI, 3–13%), and that of preterm birth was 37% (18 studies, 342 pregnancies; 95% CI, 24–52%). Worsening of preexisting diabetes or development of gestational diabetes was reported in 24% (16 studies, 344 pregnancies; 95% CI, 13–39%), whereas hypertensive disorders of pregnancy (HDP) occurred in 39% (19 studies, 362 pregnancies; 95% CI, 23–58%). Among 134 pregnancies, only one thromboembolic event was reported. The perinatal mortality rate was 7% (18 studies, 342 newborns; 95% CI, 3–14%), low birth weight was 26% (11 studies, 113 newborns; 95% CI, 15–43%), and congenital malformations were 1% (11 studies, 306 newborns; 95% CI, 0–7%). A meta-analysis of four studies revealed that uncontrolled hypercortisolism was associated with higher odds of HDP, diabetes, and preterm birth. These findings suggest that pregnancy in women with uncontrolled CS is associated with an increased risk of adverse maternal and fetal outcomes.
Temozolomide in aggressive and metastatic pituitary tumors: a Brazilian multicenter real-world cohort study Isabelle Pinheiro Amaro de Magalhães, Camila Regina Pereira Batista de Macedo, Luciana Ansaneli Naves, Mauro Antonio Czepielewski, Isabella Naves Rosa, Lidiana Bandeira de Santana, Tobias Skrebsky de Almeida, Mario Padula, Paula Condé Lamparelli Elias, Margaret de Castro, Leandro Kasuki, Monica Roberto Gadelha, Carolina Garcia Soares Leães Rech, Heraldo Mendes Garmes, Cesar Luiz Boguszewski, Raquel Soares Jallad, Marilena Nakaguma, Maria Candida Barisson Villares Fragoso, Marcio Carlos Machado, Andrea Glezer, Malebranche Berardo Carneiro da Cunha Neto, Olavo Feher, Rafael Loch Batista Pituitary, 2026 To evaluate the real-world efficacy and safety of temozolomide (TMZ) in aggressive and metastatic pituitary neuroendocrine tumors in a Latin American setting, and to address whether TMZ achieves meaningful radiological and biochemical disease control with acceptable toxicity. We conducted a retrospective multicenter study across Brazilian reference centers including patients with aggressive/metastatic pituitary adenomas treated with TMZ and followed for ≥ 6 months. The radiological response was assessed via RECIST 1.1. For functioning pituitary adenomas, biochemical response was assessed using prespecified hormonal criteria. Adverse events were collected from medical records. Thirty patients were included (mean age 29.5 years; 53% female). All the tumors were macroadenomas, and 56% were giant (> 4 cm). Twenty-one pituitary adenomas were functioning and four were metastatic. Ki-67 was > 3% in 73% of the patients. The mean time from diagnosis to TMZ initiation was 102 months. The radiological disease control rate (partial response or stable disease) was 93.3%. Among functioning tumors, the biochemical disease control rate was 81.2%, with an objective biochemical response rate (complete + partial response) of 68.8%. Adverse events, most commonly nausea and myelotoxicity, occurred in 66% of patients. In this multicenter Brazilian real-world cohort, TMZ provided high radiological and biochemical disease control with an acceptable safety profile, suggesting that TMZ is the preferred first-line systemic chemotherapy for aggressive/metastatic pituitary adenomas after the failure of standard therapies.
Approach to the Patient With Dopamine-Resistant Microprolactinoma Andrea Glezer, Matheo Augusto Morandi Stumpf, Nara Lima Queiroz Journal of Clinical Endocrinology and Metabolism, 2026 Prolactinoma is a significant cause of hyperprolactinemia and the most common type of pituitary tumor. Women of fertile age are most commonly affected, and the clinical picture is characterized by galactorrhea, oligo-amenorrhea, and infertility. In microprolactinomas, which represent more than 60% of cases in women before menopause, there is usually no concern about the mass effect. Therefore, management can be expectant if there are no symptoms or in a patient in the postmenopausal period; oral contraceptive in the presence of hypogonadism and no desire for pregnancy; dopamine agonist (DA) in the presence of bothersome galactorrhea, hypogonadism, and the desire for fertility; and neurosurgery in selected noninvasive cases. Resistance to DA occurs in less than 10% of cases. Although the reduction in dopamine receptor subtype 2 expression is considered the primary cause of DA resistance, the underlying mechanisms are not yet completely elucidated. The main concern in resistant cases is the risk of symptomatic tumor growth during assisted reproduction techniques and pregnancy. Other conditions in which hyperprolactinemia could be implicated, such as metabolic parameters, osteoporosis, and breast cancer risk are also discussed. Understanding the mechanisms of DA resistance can lead to the opening of new treatment strategies.
Pituitary incidentaloma: a Pituitary Society international consensus guideline statement Maria Fleseriu, Mark Gurnell, Ann McCormack, Hidenori Fukuoka, Andrea Glezer, Fabienne Langlois, Theodore H. Schwartz, Yona Greenman, Nidhi Agrawal, Amit Akirov, Irina Bancos, Cristina Capatina, Frederic Castinetti, Michael Catalino, Mirjam Christ-Crain, Liza Das, Andjela Drincic, Pamela U. Freda, Monica R. Gadelha, Andrea Giustina, Felicia Hanzu, Ken K. Y. Ho, Kristina Isand, Susana Mallea-Gil, Adam N. Mamelak, Hani J. Marcus, Meliha Melin Uygur, Mark Molitch, Lisa B. Nachtigall, Elisabeth Nowak, Alberto M. Pereira, Maria M. Pineyro, Ismat Shafiq, Luis Syro, Yutaka Takahashi, Elena V. Varlamov, Greisa Vila, Gabriel Zada, Niki Karavitaki, Shlomo Melmed, , , Theodore H. Schwartz, and Nature Reviews Endocrinology, 2025
Ectopic GHRH production: revisiting a rare cause of acromegaly Matheo A. M. Stumpf, Nathalie Oliveira Santana, Marcio Carlos Machado, Felipe H. Duarte, Andrea Glezer, Gérald Raverot, Véronique Raverot, Raquel S. Jallad Reviews in Endocrine and Metabolic Disorders, 2025
Hyperprolactinemia in women: diagnostic approach Andrea Glezer, Heraldo Mendes Garmes, Leandro Kasuki, Manoel Martins, Paula Condé Lamparelli Elias, Vania dos Santos Nunes Nogueira, Ana Carolina Japur de Sá Rosa-e-Silva, Gustavo Arantes Rosa Maciel, Cristina Laguna Benetti-Pinto, Andrea Prestes Nácul Revista Brasileira De Ginecologia E Obstetricia, 2024
Hyperprolactinemia in women: treatment Cristina Laguna Benetti-Pinto, Andrea Prestes Nácul, Ana Carolina Japur Rosa e Silva, Gustavo Arantes Rosa Maciel, Vania dos Santos Nunes Nogueira, Paula Condé Lamparelli Elias, Manoel Martins, Leandro Kasuki, Heraldo Mendes Garmes, Andrea Glezer Revista Brasileira De Ginecologia E Obstetricia, 2024
Management of hypopituitarism: A perspective from the Brazilian society of endocrinology and metabolism Heraldo Mendes Garmes, César Luiz Boguszewski, Paulo Augusto Carvalho Miranda, Manoel Ricardo Alves Martins, Silvia Regina Correa da Silva, Julio Zaki Abucham, Nina Rosa de Castro Musolino, Lucio Vilar, Luiz Henrique Corrêa Portari, Mônica Roberto Gadelha, Leandro Kasuki, Luciana Ansaneli Naves, Mauro Antônio Czepielewski, Tobias Skrebsky de Almeida, Felipe Henning Gaia Duarte, Andrea Glezer, Marcello Delano Bronstein Archives of Endocrinology and Metabolism, 2021
Management of pituitary tumors in pregnancy Andrea Glezer, Raquel S. Jallad, Marcio C. Machado, Marcello D. Bronstein Pituitary Tumors A Comprehensive and Interdisciplinary Approach, 2021
A Brazilian multicentre study evaluating pregnancies induced by cabergoline in patients harboring prolactinomas B. G. Sant’ Anna, N. R. C. Musolino, M. R. Gadelha, C. Marques, M. Castro, P. C. L. Elias, L. Vilar, R. Lyra, M. R. A. Martins, A. R. P. Quidute, J. Abucham, D. Nazato, H. M. Garmes, M. L. C. Fontana, C. L. Boguszewski, C. B. Bueno, M. A. Czepielewski, E. S. Portes, V. S. Nunes-Nogueira, A. Ribeiro-Oliveira, R. P. V. Francisco, M. D. Bronstein, A. Glezer Pituitary, 2020
Pituitary Physiology During Pregnancy and Lactation Raquel Soares Jallad, Andrea Glezer, Marcio Carlos Machado, Marcello D. Bronstein Maternal Fetal and Neonatal Endocrinology Physiology Pathophysiology and Clinical Management, 2020
Pituitary Disorders During Pregnancy and Lactation Raquel Soares Jallad, Andrea Glezer, Marcio Carlos Machado, Marcello D. Bronstein Maternal Fetal and Neonatal Endocrinology Physiology Pathophysiology and Clinical Management, 2020
Pituitary Disorders During Pregnancy and Lactation Raquel Soares Jallad, Andrea Glezer, Marcio Carlos Machado, Marcello D. Bronstein Maternal Fetal and Neonatal Endocrinology Physiology Pathophysiology and Clinical Management, 2019
Pituitary Physiology During Pregnancy and Lactation Raquel Soares Jallad, Andrea Glezer, Marcio Carlos Machado, Marcello D. Bronstein Maternal Fetal and Neonatal Endocrinology Physiology Pathophysiology and Clinical Management, 2019
Filamin A and DRD2 expression in corticotrophinomas Thais Sickler, Ericka Barbosa Trarbach, Fernando Pereira Frassetto, Juliano Bertollo Dettoni, Venâncio Avancini Ferreira Alves, Maria Candida Barisson Villares Fragoso, Marcio Carlos Machado, Ellison Fernando Cardoso, Marcello Delano Bronstein, Andrea Glezer Pituitary, 2019
Rare Sellar Lesions Andrea Glezer, Diane Belchior Paraiba, Marcello Delano Bronstein Endocrinology and Metabolism Clinics of North America, 2008
Diagnosis and management of hyperprolactinemia: Results of a Brazilian multicenter study with 1234 patients L. Vilar, M. C. Freitas, L. A. Naves, L. A. Casulari, M. Azevedo, R. Montenegro, A. I. Barros, M. Faria, G. C. Nascimento, J. G. Lima, L. H. Nóbrega, T. P. Cruz, A. Mota, A. Ramos, A. Violante, A. Lamounier Filho, M. R. Gadelha, M. A. Czepielewski, A. Glezer, M. D. Bronstein Journal of Endocrinological Investigation, 2008