Management of prolactinomas during pregnancy

Prolactinomas constitute approximately 40% of hormone-secreting pituitary tumors. In women the main clinical features are menstrual disorders and infertility. Successful treatment with dopamine agonists restores the normal function of the pituitary-gonadal axis, ovulation, and fertility. Adequate management of pregnant prolactinoma patients from the moment of conception is of particular importance for both the mother and the developing fetus. This review article presents current opinions on the course and management of pregnancies in patients with prolactin-secreting pituitary tumors. The introduction contains background information on clinical aspects of the condition, including prolactinoma treatment in women of reproductive age. Physiological changes in the pituitary during normal pregnancy are also described. The next part presents current knowledge on the effect of pregnancy on prolactinoma size, including especially the high risk of prolactinoma growth in patients with pituitary macroadenomas. Safety issues concerning the use of dopamine receptor agonists during pregnancy are also discussed, especially in terms of the risk of congenital defects in the fetus. Moreover, the article presents principles of prolactinoma management in pregnant patients, rare indications for surgical treatment during pregnancy, and the issues concerning pituitary tumor apoplexy in pregnant women, the last being a life-threatening condition. The final part of the article discusses the possible effects of pregnancy on hyperprolactinemia remission as well as on the issue of breastfeeding by mothers with prolactinoma.