Endocrine Abstracts

Introduction: Infertility is a classic consequence of prolactinoma in women. The treatment of hyperprolactinemia allows the restoration of ovulatory cycles and therefore of fertility in 80–90% of cases.

Methods and materials: The study is a retrospective cohort study done over 17 years from 2000 to 2017. It includes 77 cases of prolactinomas among which 12 women had one or more pregnancies after the diagnosis of prolactinoma.

Results: Among our 12 patients, 10 of them were presented for primary infertility. The average age of patients at the time of pregnancy was 39.9 years (19–44 years). In these patients, 4 had one or more abortions during the first trimester of pregnancy. It was a microprolactinoma in 10 cases with an average size of 5.4 mm (range 0 to 14 mm). All women were medically treated before pregnancy. During pregnancy, no clinical worsening was reported in these patients. Two women had pituitary MRI. Imaging showed stable microprolactinoma for one patient and macroprolactinoma increasing in size for the other. Treatment with agonist dopaminergic was discontinued on the discovery of pregnancy in nine patients and continued in three patients. The continuation of the treatment was indicated in a woman in front of the increase of the size of the adenoma in the MRI. For the other two women, they did not consult during their pregnancies. All women had vaginal birth. Two deliveries were premature. No cases of neonatal malformation were noted. The resumption of medical treatment was done 8 months after delivery (range 3–12 months) for all patients. The majority of women were breastfeeding (9 cases). There were 7 cases of microprolactinoma and 2 cases of macroprolactinoma. The duration of breastfeeding was on average 11.6 months with extremes ranging from 1 month to 24 months. None of these women showed worsening clinical signs or increased prolactin levels during lactation.

Conclusion: The reduction of size tumor or disappearance of prolactinoma on MRI before pregnancy are considered as predictive factors of remission. For this, the evolution of the tumor size during pregnancy is different according to whether it is a micro- or a macroprolactinoma.