Endocrine Abstracts

Objective: The aim of the study is to evaluate both the long-term consequences of exposure to dopamine agonists (CAB and BRC) at the beginning and during pregnancy, and the effects of pregnancy on remission.

Methods: Thirty-seven prolactinoma patients who developed 58 pregnancies while receiving DAs treatment were included in this retrospective study. Age of gestation; both maximum residual tumor diameter and PRL levels before conception; the course of prolactinoma during and after pregnancy; the outcomes of pregnancies; comorbidities and complications during pregnancy and health of fetus were evaluated. Remission was defined as regained normal gonadal function with normal PRL level after discontinuation of DA therapy.

Results: 58 pregnancies occurred under BRC (n:40) and CAB (n:18). The mean gestational age was 30 ± 5 years (range 20–39), the mean maximum tumor diameter before pregnancy was 6.3 ± 3.5 mm, and median PRL level was 32 ng/dl (range 1–15). Average treatment period until conception is 9 months for BRC and 7 months for CAB. Average cumulative CAB dose was 5mg for the first 6 weeks of gestation. BRC and CAB was discontinued in patients whose adenoma decreased significantly before conception, while the others continued throughout the pregnancy (n:13). No one had visual complaints during their pregnancy. Eighty-one percent of pregnancies resulted with live birth (15 CAB/33 BRC) and 19% with spontaneous abortion (3 CAB/8 BRC). The mean follow-up time after gestation was 7.5 ± 5.5 years (range 1–23). Among the babies, one Down syndrome (mother’s exposure was 325mg BRC during gestation) and one low birth weight baby (mother’s exposure was 2 mg CAB during first weeks of gestation) were seen. Gestational diabetes was detected in 3 mothers (2 CAB/1 BRC). In the pituitary MRI after cessation of lactation, the tumor disappeared in 8 and was stable in others. Data on postpartum menstrual periods were available in 44 cases, and cycles were spontaneous in 31% of them. After delivery, 32% of the patients (4 CAB/8 BRC) were found to be in remission for 6.5 years. Other than one, all children are healthy and successful in a period of up to 23 years.

Conclusion: No side effects of DA exposure on fetus development were observed at the beginning of pregnancy or during pregnancy. Because of the possibility of spontaneous menses patients should be carefully evaluated before re-administration of DA.