Management of lactotroph adenoma (prolactinoma) during pregnancy
- Peter J Snyder, MD
Peter J Snyder, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Pituitary Disease; Male Reproductive Endocrinology
- Professor of Medicine
- University of Pennsylvania School of Medicine
- Section Editors
- David S Cooper, MD
David S Cooper, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Pituitary Disease; Thyroid Disease
- Professor of Medicine and International Health
- Johns Hopkins University School of Medicine
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
Lactotroph adenomas (prolactinomas) usually cause infertility because of the inhibitory effect of elevated prolactin and sometimes because of the mass effect of a macroadenoma on gonadotropin secretion, resulting in anovulation and decreased estradiol and progesterone secretion. However, our ability to treat both of these abnormalities allows most women with this disorder to become pregnant. Management during pregnancy is based on knowledge of the risks to the mother and the fetus.
The management of women with lactotroph adenomas during pregnancy will be reviewed here. Other aspects of hyperprolactinemia and lactotroph adenomas are reviewed separately. (See "Clinical manifestations and evaluation of hyperprolactinemia" and "Causes of hyperprolactinemia" and "Management of hyperprolactinemia".)
Most women with lactotroph adenomas have anovulatory infertility and even frank hypogonadism but are able to conceive once their serum prolactin concentrations are normalized. Management should begin before lowering the prolactin concentration with a discussion about the risks of pregnancy on adenoma growth and the potential effects of exposure to dopamine agonists on the fetus. Current data suggest that neither bromocriptine nor cabergoline use during the first month of pregnancy harms the fetus. However, few data are available about the risk of either drug later in pregnancy.
Goals of treatment — The main goals of treatment for women with lactotroph adenomas considering pregnancy include:
●Women with microadenomas – Lower serum prolactin into the normal range to allow spontaneous ovulation.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Goals of treatment
- Before pregnancy
- - Discuss risk of adenoma growth
- - Macroadenomas
- Dopamine agonists to decrease size
- Indications for surgery
- - Restoration of ovulation
- Dopamine agonist therapy
- - Risks to fetus
- Choice of drug
- During pregnancy
- - Monitoring
- Serum prolactin
- Visual field testing
- Pituitary MRI
- - Treatment of enlarging adenoma
- - Pituitary apoplexy
- After pregnancy
- - Breastfeeding and dopamine agonists
- - Normalization of prolactin after pregnancy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS