Endocrine Abstracts

Pregnancy is associated with an increased risk of tumor growth in macroprolactinoma leading to discuss surgery in such cases.

Objectives: Impact of pregnancy on prolactin secretion and tumor growth in a cohort of women with macroprolactinoma, including large tumors >20 mm, and medically treated.

Methods: Retrospective study of all the women with macroprolactinomas diagnosed in two university hospitals, treated by dopamine agonists, with at least one pregnancy after diagnosis.

Results: A total of 38 women, 82 spontaneous pregnancies, 64 children for 35 women.

On diagnosis: mean age 23 years, median prolactin level 305 μg/l (90–7804), prolactin level ≥500 μg/l in 15 women, median tumor size 15 mm (size ≥20 mm in 12 cases), abnormal visual field in 7 cases.

Before pregnancy, 16 patients received cabergoline, 20 bromocriptine, 2 quinagolide. Prolactin level was controlled in 37 women. Visual troubles disappeared totally in 6 patients, partially in one.

Residual tumor was not visible on RMI in 10 patients, ≥10 mm in 11 (maximum 23 mm). During pregnancy, medical treatment was stopped in 20 patients (5 adenomas ≥20 mm). 8 patients had symptomatic (5 headache, 3 visual troubles) tumor evolution which was controlled by dopamine agonists either reintroduction or dose increase in 7 patients. Surgery was mandatory in one case of apoplexy during pregnancy (second trimester) and one immediately post-partum.

Prolactinoma size at diagnosis, residual size after medical treatment and treatment stop during pregnancy were not statistically significant risk factors of tumor enlargement.

Conclusion: This study, performed in a large cohort, confirms that pregnancy is a risk period of symptomatic macroprolactinoma enlargement (21%) and apoplexy but no specific risk factor for adenoma growth was found. Medical treatment is able to control tumor enlargement in almost all the cases except apoplexy which requires surgery. Macroprolactinomas, even large ones, do not seem to require debulking before pregnancy.