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Endocrine Abstracts (2016) 44 N1.3 | DOI: 10.1530/endoabs.44.N1.3

Cardiff University, Cardiff, UK.


Endocrinologists are faced with three main issues when managing a woman with a prolactinoma contemplating pregnancy: restoration of fertility, consideration of the effects of dopamine agonists on the developing foetus, and the effects of the high oestrogen environment of pregnancy on prolactinoma expansion. Untreated hyperprolactinaemia leads to anovulatory menstrual cycles with resultant amenorrhoea and infertility in most patients. Therefore, treatment is usually required in order to achieve pregnancy. Dopamine agonists are very effective in restoring ovulatory cycles (>90%) and fertility, and are generally used in preference to transsphenoidal surgery. Cabergoline is better tolerated than bromocriptine and has better efficacy in restoring ovulatory cycles, hence is usually preferred. Dopamine agonists can cross the placenta. Treatment should thus be discontinued as soon as pregnancy is confirmed in order to limit drug exposure to the developing foetus. Neither drug appears to increase the risk of foetal malformations although experience with cabergoline in pregnancy is more limited. However, the data for quinagolide are currently less reassuring. Clinically relevant tumour growth occurs in approximately 2% of microprolactinomas but up to 20% of macroprolactinomas. This risk is significantly lower in patients who have previously undergone transsphenoidal surgery or radiotherapy. Prolactin rises normally during pregnancy, hence routine measurement is not helpful. Surveillance in pregnancy is thus reliant on clinical assessment, including regular formal assessment of visual fields in women with macroprolactinomas. Dopamine agonists may be recommenced to good effect in patients who develop significant tumour expansion, and transsphenoidal surgery is rarely required. There are no special requirements for delivery, other than the need for increased glucocorticoid cover in macroprolactinomas with associated hypopituitarism. Breast feeding should be encouraged in the standard manner as there is no evidence that this results in clinically important tumour expansion. However, dopamine agonists cannot be used until breast feeding is complete.

Volume 44

Society for Endocrinology BES 2016

Brighton, UK
07 Nov 2016 - 09 Nov 2016

Society for Endocrinology 

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