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Management of lactotroph adenoma (prolactinoma) during pregnancy

Peter J Snyder, MD
Section Editors
David S Cooper, MD
Charles J Lockwood, MD, MHCM
Deputy Editor
Kathryn A Martin, MD


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 the lactotroph adenoma has been treated and the serum prolactin concentration has been lowered to normal. 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.

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Literature review current through: Nov 2017. | This topic last updated: Nov 28, 2017.
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