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Prolactinomas and pregnancy.

Marcello Delano Bronstein1

  • 1Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of S. Paulo Medical School, Av 9 de Julho 3858, 01406-100, S. Paulo, SP, Brazil. mdbronstein@uol.com.br

Pituitary
|January 18, 2006
PubMed
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Dopamine agonists effectively treat prolactinomas, but pregnancy requires careful management. While bromocriptine is generally safe, macroprolactinoma patients may need closer monitoring for tumor growth during pregnancy.

Area of Science:

  • Endocrinology
  • Reproductive Medicine
  • Neurosurgery

Background:

  • Prolactinomas are common pituitary tumors, often treatable, especially for infertility.
  • Pregnancy can potentially lead to pituitary tumor growth, a concern since dopamine agonist (DA) use began.
  • Dopamine agonists are first-line therapy for prolactinomas, with surgery reserved for specific cases.

Purpose of the Study:

  • To evaluate the safety and outcomes of managing prolactinomas during pregnancy.
  • To assess the risk of tumor growth in micro- and macroprolactinomas during gestation.
  • To compare outcomes with different management strategies, including dopamine agonist use and prior surgery.

Main Methods:

  • Retrospective follow-up of 71 term pregnancies in women with microprolactinomas.

Related Experiment Videos

  • Retrospective follow-up of 51 term pregnancies in women with macroprolactinomas.
  • Analysis of tumor growth based on prior surgery, bromocriptine use, and clinical symptoms.

    • Main Results:

    • No tumor growth symptoms were observed in 22 microprolactinoma patients with prior surgery.
    • Only 2.4% of 41 pregnant patients on bromocriptine for microprolactinomas reported headaches, resolving with treatment.
    • In macroprolactinoma patients, 37% (11 of 30) treated pre-gestationally with bromocriptine experienced tumor growth symptoms, compared to none with prior surgery.

    Conclusions:

    • Dopamine agonists are generally safe in pregnancy for microprolactinomas, with bromocriptine showing a low complication rate.
    • Macroprolactinoma patients require vigilant monitoring during pregnancy, especially if treated with bromocriptine alone.
    • Management strategies include non-hormonal contraception, potential DA withdrawal, MRI confirmation of growth, and reintroduction of DA or surgery if needed.