Endocrine Abstracts

Introduction

Prolactinomas are the most common pituitary tumors and a common cause of infertility because of gonadal dysfunction, in young women. The treatment of choice is dopamine agonists, which can restore fertility and promote shrinking of the tumor in the majority of cases. Managing prolactinomas during pregnancy may be challenging. Treatment discontinuation is recommended once the pregnancy is confirmed in women with microprolactinoma. For microprolactinoma, the risk of symptomatic tumor enlargement during pregnancy is very low (<2%). Breast-feeding has no harmful effect on tumor growth. We present a case with microprolactinoma that had a good development of pregnancy and lactation period.

Case presentation

A 20-year-old female patient, was first diagnosed with left-sided, 8 mm cystic pituitary microprolactinoma 5 years ago. She began the treatment with Cabergoline 0.25 mg twice per week. Following a period of 3 years, she was periodically controlled with prolactin level and MRI. The adenoma size was constantly shrinking from 8 to 5 and then 2.6 mm. During this time, she was taking Cabergoline 0.25 mg twice per week. The last prolactin level was 1084, 49 ng/mL (108, 78 – 557, 13) approximately twice normal level, Anti TPO 6, 49 UI/mL (<34), TSH 3, 11mUI/L. 5 days later, her pregnancy was confirmed, and Cabergoline was switched to bromocriptine 2.5 mg twice per day. She took the treatment for only one month and discontinued it because of arterial hypotension. The patient warned about the risk of tumor enlargement and alarming symptoms. She had clinical follow-up every 2-3 months. She didn`t complain of anything related to diseases’ activity, and the pregnancy had no problem. She gave birth naturally at the right time a healthy boy. Her normal menstrual cycle begun 40 days postpartum. During the postpartum period and lactation, she did not take any medication, and prolactin levels were progressively decreasing from 61, 5 to 49.6 and 30.04 ng/mL (6-29.9) during a time period of 11 months.

Conclusion:

Despite discontinuation of treatment once pregnancy has been confirmed, we didn`t notice any clinical progression of microprolactinoma during pregnancy, and no further examination was indicated. During the postpartum and lactation period, prolactin levels were progressively decreasing to normal, and no medication was needed.