PRL-secreting pituitary adenomas in pregnancy

• Published in: Journal of endocrinological investigation Vol. 26; no. 1; pp. 96 - 99
• Main Authors: Chiodini, Iacopo, Liuzzi, A.
• Format: Journal Article
• Language: English
• Published: Milano Kurtis 01.01.2003
• Subjects: Adenoma - pathology; Adenoma - secretion; Adenoma - therapy; Biological and medical sciences; Cell Division; Diseases of mother, fetus and pregnancy; Embryonic and Fetal Development - physiology; Endocrinopathies; Female; Gynecology. Andrology. Obstetrics; Humans; Hypothalamus. Hypophysis. Epiphysis (diseases); Medical sciences; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Pituitary Neoplasms - pathology; Pituitary Neoplasms - secretion; Pituitary Neoplasms - therapy; Pregnancy; Pregnancy Complications, Neoplastic - metabolism; Pregnancy Complications, Neoplastic - pathology; Pregnancy Complications, Neoplastic - therapy; Pregnancy. Fetus. Placenta; Prolactin - secretion; Receptors, Dopamine D2 - agonists; Endocrinopathy; Human; Agonist; Pregnancy disorders; Bromocriptine; Toxicity; Estrogen; Ergot derivatives; Adenoma; Maternal diseases; Secretory tumor; Pregnancy; Prolactinoma; Fetal diseases; Clinical management; D2 Dopamine receptor; Pituitary diseases; Tumor progression; Hormonal regulation; Benign neoplasm
• ISSN: 0391-4097; 1720-8386
• DOI: 10.1007/BF03345132

Dopamine-agonists have significantly increased the number of pregnancies in women with micro- and macro-prolactinomas, as ovulation can be restored in the great majority of these patients. Thus, the main questions regard the possible consequences of high estrogen levels on tumor volume and the possible effects of D2-agonists on fetal development. While the risk of tumor increase is low in patients with prolactin secreting micro-adenoma (MIP), in PRL secreting macro-adenoma (MAP) patients the possibility of tumor growth is enhanced and influenced by previous treatment. Moreover, while it is well known that the exposition for only the first 4 weeks to bromocriptine (BRC) therapy does not affect the outcome of pregnancy, data on the use of BRC during the whole gestation are limited to just over 100 cases. Female pregnant patients with MIP, therefore, must be reassured and medical therapy suspended, with successive clinical follow-up. In the case of pregnant MAP subjects, the best approach from pre-pregnancy debulking, dopamine-agonist therapy interruption and BRC therapy continuation must be agreed on with the patient, and a careful follow-up instituted.