Management of prolactinomas during pregnancy

Mark E. Molitch*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

84 Scopus citations

Abstract

Infertility is a common problem for women presenting with hyperprolactinemia, and lowering of prolactin (PRL) levels to normal or near normal is often necessary to permit ovulation. Dopamine agonists are effective in a majority of women, with cabergoline somewhat more effective than bromocriptine. Bromocriptine use by the mother appears to be safe for the developing fetus when its use is discontinued four to six weeks after conception. For women with microadenomas, the subsequent risk of adenoma growth during pregnancy appears to be 1% after discontinuing the drug, and symptomatic follow-up each trimester appears to be reasonable in such patients. For women with macroadenomas, bromocriptine may be discontinued after diagnosis of pregnancy (23% risk of tumor enlargement) or continued throughout pregnancy with monthly visual field testing. Alternatively, prepregnancy debulking of the tumor may be undertaken with appropriate follow-up (2.8% risk of tumor enlargement). Although data are less extensive on cabergoline, preliminary evidence does not suggest any increase in adverse fetal outcomes. As such, therapeutic abortion is not warranted if pregnancy occurs during cabergoline treatment. The drug appears reasonably safe for continued use. Further accrual of safety data will clarify that issue.

Original languageEnglish (US)
Pages (from-to)1121-1126
Number of pages6
JournalJournal of Reproductive Medicine for the Obstetrician and Gynecologist
Volume44
Issue number12 SUPPL.
StatePublished - Dec 1 1999

Keywords

  • Bromocriptine
  • Cabergoline
  • Hyperprolactinemia
  • Prolactinoma

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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