Outcome and long-term effects of pregnancy in women with hyperprolactinaemia

Ampudia, X; Puig-Domingo, Manel; Schwarzstein, Diego; Corcoy, Rosa; Espinós, Juan José; Calaf, Joaquím; Webb, Susan M.

doi:10.1016/0028-2243(92)90253-u

Cited by 17 publications

(12 citation statements)

References 25 publications

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“…The reports included in that review are quite heterogeneous, as they dated back to the 1970s when CT scans were just starting to be used. Although some early case reports and small series were included in earlier summaries that were in that review (46,47), the reports after 1985 were included only if they had five or more cases (30,31,32,33,34,48,49,50,51,52,53,54). With respect to denoting patients with clinically significant tumor enlargement criteria were quite variable and in most of those series, symptoms consisted of progressive, severe headaches and/or visual field defects.…”

Section: Effect Of Pregnancy On Prolactinoma Sizementioning

confidence: 99%

ENDOCRINOLOGY IN PREGNANCY: Management of the pregnant patient with a prolactinoma

Molitch

2015

European Journal of Endocrinology

146

135

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A woman with a prolactinoma is usually infertile. Dopamine agonists usually restore ovulation and fertility and such treatment generally is preferred over transsphenoidal surgery because of higher efficacy and safety. Cabergoline is usually preferred over bromocriptine because of its better efficacy with fewer adverse effects. Either drug increases the rates of spontaneous abortions, preterm deliveries, multiple births, or congenital malformations over what may be expected. However, the number of pregnancies reporting such experience is about sevenfold greater for bromocriptine. Tumor growth causing significant symptoms and requiring intervention has been reported to occur in 2.4% of those with microadenomas, 21% in those with macroadenomas without prior surgery or irradiation, and 4.7% of those with macroadenomas with prior surgery or irradiation. Visual fields should be assessed periodically during gestation in women with macroadenomas. If significant tumor growth occurs, most patients respond well to reinstitution of the dopamine agonist. Delivery of the baby and placenta can also be considered if the pregnancy is sufficiently advanced. Transsphenoidal debulking of the tumor is rarely necessary. Prolactin and fertilityWomen with hyperprolactinemia usually present with symptoms of galactorrhea, menstrual disorders (usually amenorrhea), and infertility. Hyperprolactinemia decreases luteinizing hormone (LH) pulse amplitude and frequency through suppression of gonadotropin-releasing hormone (GNRH) (1, 2). This effect appears to be mediated by an earlier step of suppressing the generation of kisspeptin, a protein made by neurons in the arcuate and periventricular nuclei of the hypothalamus, which stimulates GNRH release (3). Hyperprolactinemia has been associated with loss of the positive estrogen feedback on gonadotropin secretion at mid-cycle (4) but whether this effect is mediated through kisspeptin is not known.Direct prolactin (PRL) effects on ovarian granulosa cells include stimulation of the expression of type 2

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Section: Effect Of Pregnancy On Prolactinoma Sizementioning

confidence: 99%

ENDOCRINOLOGY IN PREGNANCY: Management of the pregnant patient with a prolactinoma

Molitch

2015

European Journal of Endocrinology

146

135

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“…Uninterrupted bromocriptine treatment during gestation is still highly disputable. Neither maternal nor fetal complications were reported by Georgiev and Dokumov [24] in 1 case or by Ampudia et al [25] in 2 cases of empty sella syndrome continuously treated during pregnancy with oral bromocriptine. Unfortunately, there are no comparable data on untreated empty sella syndrome in pregnancy.…”

Section: Resultsmentioning

confidence: 96%

Pregnancy in Hyperprolactinemic Infertile Women Treated with Vaginal Bromocriptine: Report of Two Cases and Review of the Literature

Ricci

Giolo

Nucera

et al. 2001

Gynecol Obstet Invest

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Vaginal bromocriptine has proven safe and effective in treating hyperprolactinemic women. However, there has been no long-term clinical assessment regarding the influence of daily vaginal bromocriptine administration on the ability to conceive. This article presents two cases of successful pregnancy resulting from this alternative treatment. An infertile woman with an empty sella and hyperprolactinemia was treated with vaginal bromocriptine because of intolerance to oral administration. Prolactin levels were quickly normalized and no side effects occurred. Repeated postcoital tests during treatment proved normal. Twelve months later, the patient conceived. The therapy was discontinued during pregnancy, without complications. Although bromocriptine treatment was not resumed after delivery, postpartum prolactin levels were lower than before treatment and magnetic resonance imaging revealed an unchanged empty sella. Another patient with infertility and pituitary microadenoma with intolerance to oral dopaminergic agonists received the same treatment. Prolactin quickly fell to within the normal range. Vaginal bromocriptine was well tolerated and postcoital test results were not impaired. Tumor regression occurred and 10 months later the patient conceived. Despite bromocriptine withdrawal, no significant complications occurred during pregnancy. It can therefore be concluded that a couple’s fertility does not appear to be significantly affected by the persistent local presence of bromocriptine.

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“…Three months treatment with a dopamine agonist is advisable, also radiological assessment to determine that there is no residual suprasellar extension before pregnancy is attempted (12). In approximately 10% of patients with hyperprolactinemia there is instead a fall in PRL levels (36). Should symptoms such as headaches or visual impairment occur, BRC treatment is restarted and continued throughout the pregnancy.…”

Section: Pregnancymentioning

confidence: 99%

“…Once pregnancy is confirmed, BRC is discontinued and the patient is observed carefully. Lactation does not seem to present any increased risk for tumor progression after delivery (2,8,36). This strategy is probably safer than surgery, which is always associated with an increased risk for miscarriage during the first and second trimesters (2,7,12).…”

Section: Pregnancymentioning

confidence: 99%