Clinical Course and Outcome of Thirty-Five Pregnancies in Infertile Hyperprolactinemic Women

Skrabanek, Petr; McDonald, D.; Meagher, Declan; Valera, Eamonn de; Carroll, Carthage J.; Lanigan, O.; Powell, David

doi:10.1016/s0015-0282(16)44655-8

Cited by 22 publications

(4 citation statements)

References 14 publications

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“…26 suggests the need for a close monitor ing of the subjects during pregnancy, even if complications from pituitary tumor growth appear uncommon [Gemzell and Hang. 1979;Skrabanek et al, 1980], and confirms the effectiveness of bromocriptine treatment in the rapid control of tumor growth pre viously reported by others in 2 cases [Corenblam, 1979;Van Roon et al, 1981]. Preg nancy and lactation were uneventful in most cases, including successful breast feeding, at variance with a previous report [Mornex et al, 1978].…”

Section: Discussionsupporting

confidence: 84%

Spontaneous Pregnancies in Hyperprolactinemic Women

Crosignani

Scarduelli

Brambilla

et al. 1985

Gynecol Obstet Invest

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29 pregnancies occurred spontaneously in 28 women with mild to moderate hyperprolactinemia (prolactin levels up to 100 ng/ml). Only 4 of them showed tomographic evidence of microprolactinoma; 1 of the prolactinoma patients experienced a visual field defect at week 30, which was quickly controlled by bromocriptine treatment. Pregnancy was uneventful in the rest of the patients. Subjects who wished to lactate successfully breast-fed their babies. Of 22 women in whom prolactin levels were reevaluated at least 1 month after delivery and/or lactation, normal values were found in 9.

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Section: Discussionsupporting

confidence: 84%

Spontaneous Pregnancies in Hyperprolactinemic Women

Crosignani

Scarduelli

Brambilla

et al. 1985

Gynecol Obstet Invest

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“…Thirteen patients with fertility problems subsequently conceived and delivered healthy babies. Our results compare favourably to the outcome of pregnancy in other series (45)(46)(47)(48)(49)(50)(51)(52). There was n o abortion or fetal abnormality in any pregnancy in our patients and we did not observe any evidence of pituitary tumour enlargement during pregnancy as reported by Gemzell and Wang (53).…”

Section: Discussionsupporting

confidence: 87%

Hyperprolactinaemic Amenorrhoea in Hong Kong

Tang

Sung

1983

Aust NZ J Obst Gynaeco

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In a retrospective study of 595 patients attending the Menstrual Disorder Clinic from January, 1978 to December, 1981, 92 patients (15.5%) had raised serum prolactin (PRL) levels (greater than 25 ng/ml) on 2 or more separate occasions with a mean (+/- S.E.M.) value of 67.1 +/- 2.5 ng/ml. Galactorrhoea was found in 27.2% of the hyperprolactinaemic patients. Primary amenorrhoea was observed in 1 patient (1.1%) with serum PRL level of 68 ng/ml. Secondary amenorrhoea of longer than 6 months' duration occurred in 61 patients (66.3%) with mean PRL level 84.2 +/- 3.3 ng/ml. The 30 patients (32.6%) with irregular menstruation had a mean PRL level of 47.2 +/- 3.3 ng/ml. Investigations revealed that 43 patients (46.7%) had idiopathic hyperprolactinaemia, 14 patients (15.4%) had drug induced hyperprolactinaemia and 1 patient (1.1%) had hypothyroidism; 18 patients (19.5%) had suspected pituitary microadenoma and 16 patients (17.2%) had abnormal radiographic findings. Bromocriptine treatment was given to 38 patients, 13 with abnormal tomographic findings (mean serum PRL greater than 100ng/ml); 18 with suspected pituitary microadenoma (mean serum PRL 94 +/- 2.7 ng/ml) and 7 with idiopathic hyperprolactinaemia (mean serum PRL 65 +/- 4.7 ng/ml). All patients (38/38) responded to treatment with restoration of menstruation and cessation of galactorrhoea within 1 to 3 months. Mean PRL level was 21.6 +/- 5.2 ng/ml at the time of response. Thirteen patients subsequently became pregnant and all delivered healthy babies.

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“…[91][92][93] Of note, female patients desiring fertility should be preferentially placed on bromocriptine, as it had a more well-characterized safety profile. [94][95][96][97][98] In some individuals, medical monotherapy may provide a sustained cure. 99 Colao et al reported 64 to 69% sustained remission at 5 years after a 2-year treatment period with cabergoline, a marked improvement over 7 to 38% described previously after cessation of bromocriptine.…”

Section: Medical Management and The Role Of Deferred Surgerymentioning

confidence: 99%

Pediatric Pituitary Adenoma: Case Series, Review of the Literature, and a Skull Base Treatment Paradigm

et al. 2018

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Pediatric pituitary adenoma is a rare skull base neoplasm, accounting for 3% of all intracranial neoplasms in children and 5% of pituitary adenomas. Compared with pituitary tumors in adults, secreting tumors predominate and longer disease trajectories are expected due to the patient age resulting in a natural history and treatment paradigm that is complex and controversial. The aims of this study were to describe a large, single-institution series of pediatric pituitary adenomas with extensive long-term follow-up and to conduct a systematic review examining outcomes after pituitary adenoma surgery in the pediatric population. The study cohort was compiled by searching institutional pathology and operative reports using diagnosis and site codes for pituitary and sellar pathology, from 1956 to 2016. Systematic review of the English language literature since 1970 was conducted using PubMed, MEDLINE, Embase, and Google Scholar. Thirty-nine surgically managed pediatric pituitary adenomas were identified, including 15 prolactinomas, 14 corticotrophs, 7 somatotrophs, and 4 non-secreting adenomas. All patients underwent transsphenoidal resection (TSR) as the initial surgical treatment. Surgical cure was achieved in 18 (46%); 21 experienced recurrent/persistent disease, with secondary treatments including repeat surgery in 10, radiation in 14, adjuvant pharmacotherapy in 11, and bilateral adrenalectomy in 3. At the last follow-up (median 87 months, range 3-581), nine remained with recurrent/persistent disease (23%). Thirty-seven publications reporting surgical series of pediatric pituitary adenomas were included, containing 1,284 patients. Adrenocorticotropic hormone (ACTH)-secreting tumors were most prevalent (43%), followed by prolactin (PRL)-secreting (37%), growth hormone (GH)-secreting (12%), and nonsecreting (7%). Surgical cure was reported in 65%. Complications included pituitary insufficiency (23%), permanent visual dysfunction (6%), chronic diabetes insipidus (DI) (3%), and postoperative cerebrospinal fluid (CSF) leak (4%). Mean follow-up was 63 months (range 0-240), with recurrent/persistent disease reported in 18% at the time of last follow-up. Pediatric pituitary adenomas are diverse and challenging tumors with complexities far beyond those encountered in the management of routine adult pituitary disease, including nuanced decision-making, a technically demanding operative environment, high propensity for recurrence, and the potentially serious consequences of hypopituitarism with respect to fertility and growth potential in a pediatric population. Optimal treatment requires a high degree of individualization, and patients are most likely to benefit from consolidated, multidisciplinary care in highly experienced centers.

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Clinical Course and Outcome of Thirty-Five Pregnancies in Infertile Hyperprolactinemic Women

Cited by 22 publications

References 14 publications

Spontaneous Pregnancies in Hyperprolactinemic Women

Spontaneous Pregnancies in Hyperprolactinemic Women

Hyperprolactinaemic Amenorrhoea in Hong Kong

Pediatric Pituitary Adenoma: Case Series, Review of the Literature, and a Skull Base Treatment Paradigm

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