Giant macroprolactinoma and pregnancy

Abstract

Prolactinomas are a common cause of gonadal dysfunction and infertility. We present the case of a 38-year-old woman with history of amenorrhea and infertility. At seven weeks of pregnancy she presented neuro-ophthalmologic complaints of headaches, diplopia, and right ptosis. The work-up study revealed an invasive pituitary macroadenoma with a maximum diameter of 9 cm and serum prolactin of 25,800 ng/mL (3-20). At 12 weeks, she was referred to the Endocrinology Department of the Coimbra University Hospital and started therapy with bromocriptine, initially 5 mg/day and then at crescent doses. Hyperprolactinemia was rapidly and drastically reduced to 254 ng/mL three weeks after taking bromocriptine 15 mg/day. Tumoral volume was reduced and there was improvement of III pair paresis. At 38 weeks, a male healthy baby was born. This is a relevant clinical case that illustrates the efficacy and safety of bromocriptine therapy during pregnancy, even in severe cases like this one.

THERAPY OF ENDOCRINE DISEASE: The challenges in managing giant prolactinomas

“…In a recent review (15), we collected data from 34 patients and are now aware of four further cases (36,95,96,97). The female:male ratio is around 1:9 ((15) Table 1).…”

“…We also observed a gender-related difference in the distribution of giant prolactinomas by decades of life (15). In men, the incidence peaks during the fourth decade of life and then decreases sharply, pointing towards a 'frailty' effect, whereas in women, the diagnosis period seems to have a bimodal distribution with an early-onset group of 11 patients with a median age at diagnosis of 25 years (range [15][16][17][18][19][20][21][22][23][24][25][26][27] (15,95) and a later onset group of 27 patients diagnosed at a median age of 50 years (range 37-87) (15,36,96,97). Early onset may reflect a stronger hereditary pathogenesis, and systematic search for MEN1 or AIP mutations would be interesting in this setting.…”

Analysis of bromocriptine treatment in pregnant pituitary prolactinoma patients

“…Patient vision should be checked monthly; if tumor growth leads to vision impairment, headaches, or other related symptoms, the amount of medication should be increased throughout pregnancy until childbirth. Clinical reports showed that taking bromocriptine pre-or postpregnancy would not increase miscarriage, ectopic pregnancy, choriocarcinoma, or the incidence of congenital malformations [15]. Cheng et al [16] suggest that pituitary microadenoma patients, in particular those who received medication or underwent surgery before pregnancy, should add bromocriptine to quickly control symptoms when signs of tumor growth occur during pregnancy [17].…”