Management of prolactinoma during pregnancy and postpartum

Abstract

Prolactinoma is classified as microprolactinoma when it measures <10 mm and macroprolactinoma when it measures ≥10 mm. Prolactinoma is an important cause of amenorrhea and infertility in premenopausal female. With early diagnosis and treatment with dopamine agonist, many patients have restoration of fertility within few months of treatment. In presence of estrogenic environment of pregnancy there is a tendency for prolactinoma to increase in size during pregnancy. This may be associated with visual field compromise and rarely pituitary apoplexy. This review discusses some key points in management of prolactinoma during pregnancy and postpartum. In case of microprolactinoma, the risk of complications are low hence it is recommended to keep a close follow up of patient without any need for intervention. In case of macroprolactinoma it is recommended to use barrier contraception to prevent pregnancy for at least 6-12 months after detection and starting treatment to allow proper shrinkage of the tumor with dopamine agonist. Once pregnancy is confirmed -In those with low risk features, dopamine agonist is stopped and a close follow up is advised. In those with high risk features, it is recommended to continue the dopamine agonist therapy with a close follow up. Postpartum period generally doesn't pose much threat to prolactinoma and treatment may be discontinued if patient wishes to breast feed her infant.

Keywords

• hyperprolactinemia and pregnancy
• prolactinoma and pregnancy
• prolactinoma and postpartum