Prolactinomas in pregnancy: considerations before conception and during pregnancy

Area of Science:

• Endocrinology
• Reproductive Medicine
• Neurosurgery

Background:

• Prolactinomas are common pituitary tumors causing hyperprolactinemia and infertility.
• Dopamine agonists (DAs) are the primary treatment, reversing symptoms and shrinking tumors.
• Pregnancy in women with prolactinomas is increasingly reported.

Purpose of the Study:

• To outline management strategies for prolactinomas during pregnancy.
• To discuss the risks and benefits of dopamine agonist therapy in pregnancy.
• To define indications for surgery in cases of tumor growth during pregnancy.

Main Methods:

• Review of current literature on prolactinoma management in pregnancy.
• Analysis of dopamine agonist use (bromocriptine vs. cabergoline).
• Guidelines for monitoring tumor growth and fetal exposure.

Main Results:

• Dopamine agonists are effective, with bromocriptine often preferred.
• Discontinuation of DAs is recommended for smaller tumors upon pregnancy confirmation.
• Maintenance of DAs may be considered for invasive macroprolactinomas.
• Surgery is reserved for DA-resistant or symptomatic tumor growth.

Conclusions:

• Careful management of prolactinomas during pregnancy is crucial.
• Individualized treatment decisions are necessary based on tumor size and invasiveness.
• Close monitoring and timely intervention can ensure favorable outcomes for mother and fetus.