Endocrine Abstracts

The purpose of the study was to study the characteristics of the course of pregnancy and childbirth in women with prolactinomas, as well as the effect of pregnancy on the size and functional activity of prolactin-secreting pituitary adenomas.

Materials and methods: 70 women with prolactinomas during pregnancy were examined. The age of the examined patients from 20 to 38 years (28.9 ± 0.5 years). The duration of the disease ranged from 3 months to 20 years and averaged 2.8 ± 0.2 years. The menarche age ranged from 11 to 18 years and averaged 13.2 ± 0.2 years. A regular menstrual cycle before pregnancy was present in 6 (8.5%) patients with prolactinoma. Opsomenorrhea was present in 30 (42.8%) and amenorrhea 15 (21.4%). Before pregnancy, lactorrhea of I-II degree was present in 40 (57.1%) women, III degree – in 7 (10%) women. Pregnancy occurred during therapy with dopamine agonists. 6 (8.5%) patients underwent stimulation of ovulation with clomiphencitrate. Three (4.2%) women with macroprolactinoma had asymmetric bitemporal hemianopsia. 10 (14.2%) patients in the past underwent surgery on the pituitary gland. In 2 (2.8%) patients with pituitary macroadenoma, surgical treatment was combined with radiation therapy. Microadenomas were present in 51 (72.8%) patients, macroadenomas – in 19 (27.1%) women. The sizes of prolactin before pregnancy ranged from 3 mm to 42 mm (9.2 ± 1.0 mm). The average tumor size in patients with pituitary microadenoma was 5.0 ± 0.3 mm, with macroadenoma – 18.0 ± 1.8 mm. The level of prolactin in the blood of patients ranged from 900 mIU/l to 10,000 mIU/l and averaged 3361.8 ± 307.2 mIU/l.

Results: With microadenomas due to the low risk of tumor growth, observation without treatment is possible based on clinical symptoms. With macroadenomas, pregnancy must be planned to achieve control of tumor growth. Careful observation or treatment with dopamine agonists throughout pregnancy is preferred, depending on the particular patient. To minimize risks to the fetus, treatment with dopamine agonists should be started after the first trimester. Breastfeeding may be allowed, as there is insufficient evidence against this. Patients requiring dopamine agonists to prevent tumor growth should continue treatment, although lactation may be impaired.

Conclusion: Preference is given to careful observation or treatment with dopamine agonists throughout pregnancy, depending on the particular patient.