REVIEW  HOW TO HANDLE PITUITARY DISEASE DURING PREGNANCY 

Minerva Endocrinologica 2018 December;43(4):423-9

DOI: 10.23736/S0391-1977.17.02792-4

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Prolactinomas: how to handle prior to and during pregnancy?

Andrea GLEZER, Marcello D. BRONSTEIN ✉

Unit of Neuroendocrinology, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil

Prolactinomas are the most common cause of pathological hyperprolactinemia, leading to central hypogonadism and, therefore, a frequent etiology of infertility. Treatment, usually with dopamine agonist (DA), can reverse hyperprolactinemia and hypogonadism, allowing pregnancy in the majority of cases. Bromocriptine is still the DA of choice for such purpose. Important issues in DA-induced pregnancies include fetal exposition, both malformations and neuropsychological development and tumor size increase. Regarding microprolactinomas and intrasellar macroprolactinomas, DA should be withdrawn as soon as pregnancy is confirmed. In expansive/invasive macroprolactinomas, DA maintenance should be individualized. Patient follow-up includes periodically clinical evaluation, sellar imaging only indicated in the presence of tumor mass effects related symptoms. Neurosurgery, both before and during gestation, is indicated in cases in which DA treatment failed. Breastfeeding is usually allowed. As tumor volume decrease and remission of hyperprolactinemia may occur after pregnancy, serum prolactin levels and tumor status should be reevaluated.

KEY WORDS: Prolactinoma - Pregnancy - Bromocriptine - Cabergoline