Endocrine Abstracts

Introduction: It is well-known that prolactinomas sometimes resolve following pregnancy. We wanted to see how often this happens and pregnancy outcome.

Patients and methods: From mid 2008 to mid 2013, 66 patients with hyperprolactinemia were studied. 39 had definite microprolactinomas, four probable microprolactinomas, three macroprolactinomas, eight nontumoral hyperprolactinemia and 12 patients were diagnosed elsewhere so no scan results were available. 54 out of 66 patients (82%) were on DA therapy prior to pregnancy, which was discontinued within 6–8 weeks of gestation. The incidence of miscarriage, foetal malformations and premature delivery were analysed.

Results: There were 51 (77.3%) live births and two miscarriages (3%).One patient (44 years) had termination for Down’s syndrome. One had premature delivery secondary to chorioamnionitis resulting in neonatal death. There was no clear perinatal data available in 11/66 (16.7%). There were no neonatal malformations noted in all live births. Only four out of 66 patients needed to restart on DAs after lactation. 93.9% didn’t require any further treatment, assuming that the prolactin was normal in those women whose prolactin was not rechecked following breastfeeding. All three with macroprolactinomas had a significantly lower prolactin after lactation compared to their initial level. Only one patient had tumour enlargement during pregnancy which required treatment and even she didn’t require DA therapy after lactation. Patients with microprolactinomas were often discharged to GP to have a prolactin level checked after lactation. However, only 57.6% of patients had it done.

Conclusions: Foetal exposure to DAs at conception did not appear to increase risk of miscarriage/malformations. Pregnancy was associated with normalisation of prolactin levels in 93.9% of patients, including all macroprolactinomas. As the majority of patients did not have a prolactin checked after they had finished breast feeding more rigorous follow up arrangements are needed.