Giant macroprolactinoma and pregnancy.

Area of Science:

• Endocrinology
• Neuro-oncology
• Reproductive Medicine

Background:

• Prolactinomas, pituitary tumors secreting prolactin, are a frequent cause of hormonal imbalances affecting reproductive health.
• Hyperprolactinemia can lead to gonadal dysfunction, amenorrhea, and infertility in women.
• Pituitary macroadenomas, especially invasive ones, pose significant clinical challenges.

Observation:

• A 38-year-old woman with amenorrhea and infertility presented with neuro-ophthalmologic symptoms during early pregnancy.
• Imaging revealed a large, invasive pituitary macroadenoma (9 cm) with markedly elevated serum prolactin levels (25,800 ng/mL).
• The patient experienced headaches, diplopia, and right ptosis due to the macroadenoma.

Findings:

• Bromocriptine therapy was initiated at 12 weeks of gestation, with dosage escalation.
• Rapid and significant reduction in prolactin levels to 254 ng/mL was achieved within three weeks of high-dose bromocriptine (15 mg/day).
• Tumor volume decreased, and the patient's III cranial nerve paresis (ptosis) improved.

Implications:

• This case highlights the safety and efficacy of bromocriptine in managing severe hyperprolactinemia and large pituitary macroadenomas during pregnancy.
• Successful treatment facilitated a full-term pregnancy and the birth of a healthy infant.
• Bromocriptine represents a viable therapeutic option for pregnant patients with prolactinomas, even in complex and severe presentations.