Endocrine Abstracts

JOINT2460

Introduction: Prolactinomas are the most common pituitary adenomas and are a cause of infertility due to anovulation. Their treatment restores normal fertility. During a normal pregnancy, oestrogens cause hyperplasia of the lactotropic cells, responsible for hyperprolactinaemia and pituitary hyperplasia on MRI. Pregnancy in a patient with a prolactinoma poses several problems.

Observation: 1st case: We report the case of a patient aged 40 years, followed for a macroprolactinoma, revealed at age 32, by secondary amenorrhea and bilateral galactorrhea, associated with a tumor syndrome. At the bill, hyperprolactinaemia at 305.60 ng/ml with pituitary MRI: a left lateralized pituitary nodular formation measuring: 10*8 mm. The patient was placed on cabergoline 0.5 mg: 4 cp/week, with a progressive decrease and then normalization of prolactinemia. After 7 years of treatment, the patient consults for pregnancy at 12 SA. The course of action was to reduce the dose of cabergoline to 0.5 mg/week and schedule monthly clinical follow-up. 2nd case: 33-year-old patient, followed for macroprolactinoma since the age of 25, revealed by a secondary amenorrhea, with a tumor syndrome, diplopia and galactorrhea. With an MRI pituitary adenoma occupying the entire saddle cavity measuring 11x 10 x 11 mm and a prolactinemia at 563.80 ng/ml. Treated with cabergoline, the course was marked by pregnancy. The course of action was to continue the cabergoline and schedule regular follow-up.

Discussion: When a patient has a prolactin adenoma, pregnancy will be achieved in the vast majority of cases with precautions depending on the initial tumor size. The risk of developing microprolactinomas is low, allowing for a discontinuation of dopamine agonists once pregnancy has been diagnosed. The approach differs in the case of macroprolactinomas, where the risk of progression is higher and therefore the continued dopaminergic agonist therapy during pregnancy is justified. Monitoring involves monthly clinical check-up and possibly a detailed neuroophthalmological examination, the frequency of which will depend on visual symptoms and the pre-pregnancy situation (size of the tumour; proximity of the optic pathways; presence or absence of a visual deficit before pregnancy). A pituitary MRI without contrast should be performed in case of symptoms suggestive of tumor progression or apoplexy (headaches; deficit of acuity or visual field; oculomotor disorders\.).

Conclusion: Management of macroprolactinomas during pregnancy should be cautious and monthly, because the increase in tumor volume, with a risk of apoplexy, is observed in cases reported in the literature.