Pregnancy and Tumor Outcomes in Women with Prolactinoma

Abstract

Management of prolactinomas during pregnancy has always been a challenge. There is a concern about the risk of tumor growth, as well as the effects of the treatment on the developing fetus. Another issue that has been less studied is the outcome of women with prolactinoma after pregnancy and lactation. To evaluate remission of hyperprolactinaemia after pregnancy and lactation in women with prolactinoma. To describe the safety of dopamine agonists for the fetus and pregnancy outcomes. A retrospective study of 32 pregnancies in women with prolactinoma was conducted in a single-centre. Other causes of hyperprolactinemia were excluded. Prolactin level was recorded at the time of diagnosis, during treatment, and during follow-up. The pregnancies resulted in one spontaneous abortion (3.1%) and 31 live births (96.9%). No stillbirths, multiple or ectopic pregnancies or trophoblastic disease were recorded. There was only one malformation (club foot) recorded (3.1%) and normalisation of prolactin after pregnancy without medical treatment occurred in 12% of patients. Fetal exposure to bromocriptine or cabergoline during pregnancy is not associated with an increased risk of adverse neonatal or pregnancy disclosures. There is considerable diversity among endocrinologists in the management of prolactinomas during pregnancy and after birth, which indicates that there is a need for better consensus and for carefully drawn-up guidelines to follow.

An observational study of pregnancy and post‐partum outcomes in women with prolactinoma treated with dopamine agonists

“…Pregnancy-induced hyperplasia of pituitary lactotroph cells can augment prolactinoma size and prolactin (PRL) levels. 15 Prolactinoma enlargement during pregnancy has been reported in 2.4% of microprolactinomas, 21% of macroprolactinomas (and 4.7% of macroprolactinomas previously treated with surgery or irradiation) and is attributed to the stimulatory effects of oestrogen and cessation of DA therapy. 8 Remission rates after pregnancy and lactation in women with prolactinoma (as opposed to hyperprolactinaemia) range between 12-41%.…”

Pregnancy‐induced progressive change of prolactin‐secreting macroadenoma with the development of bitemporal hemianopia and severe headache

“…In general, for term or nearly term fetuses, induction of labor before neurosurgical intervention may be reasonable. However, for previable fetuses, management is complicated; there are no published data to access the comparative risk of continuing bromocriptine treatment and surgical resection during pregnancy, though surgical resection during pregnancy in some selected cases was reported to be safe . In our case, visual field tested with Goldmann perimetry technique revealed normal results and needed no surgical treatment for enlarged pituitary gland during early pregnancy.…”

Pituitary-Directed Therapies for Cushing’s Disease

“…Cabergoline is advantageous for women in or planning pregnancy where therapeutic options are otherwise limited. Its innocuous profile during gestation has been confirmed with an increasing number of uneventful pregnancies (mostly for prolactinomas) ( 60 ). Efficacy and safety of cabergoline in CD in pregnancy is also supported by a number of case reports ( 61 – 63 ).…”