Outcome of 100 pregnancies initiated under treatment with cabergoline in hyperprolactinaemic women

Abstract

Cabergoline treatment at the time of conception appears to be safe for both the pregnancy and the neonate, although more data are still needed on a larger number of pregnancies.

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

“…The risk of symptomatic tumor enlargement for microadenomas was 2.4% (18/764), for macroadenomas that had not had prior surgery or irradiation was 21.0% (50/238), and for macroadenomas with prior surgery/irradiation was 4.7% (7/148). Routine MRI scans were performed between 24 and 32 weeks of gestation in 34 women in whom cabergoline had been stopped when pregnancy was diagnosed, finding that five of the 12 with macroadenomas had no change in tumor size, three had an increase of !5 mm, and four had an increase of O5 mm in size and nine of the 22 with microadenomas had no change in tumor size, three had a decrease, eight had an increase of !5 mm in size, and two had an increase of O5 mm in size (33). In one uncontrolled study of 22 patients, prior treatment with bromocriptine for more than 12 months seemed to reduce the risk of tumor enlargement (48); however, this finding awaits confirmation by other studies with either bromocriptine or cabergoline.…”

“…In many cases with tumor enlargement, reintroduction of the dopamine agonist, usually bromocriptine, was successful in reversing the problem and surgery was very rarely required; others were managed conservatively without medication or surgery. Cabergoline was restarted in six patients because of symptomatic headaches and/or vision-threatening increases in size of the adenomas (31,33). In some patients, postpartum PRL levels and tumor sizes are actually reduced as compared with values before pregnancy (55), but this has not been observed in all series (56).…”

“…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.…”

Expression of estrogen receptor alpha is associated with prolactin pituitary tumor prognosis and supports the sex-related difference in tumor growth

“…However, radiological evidence of tumor growth was often lacking, no histological proof of stimulation of the cell proliferation was given, and PRL tumor regrowth was mainly described after withdrawal of a short-term treatment with bromocriptine (35), which can also be the case in the absence of pregnancy (36). More recent data (37,38,39,40) indicate the absence of symptomatic tumor growth in a total of 88 women treated with cabergoline for a macroprolactinoma before pregnancy. In one study (38), routine procedure included an MRI performed without contrast injection between 24 and 32 weeks of gestation, and cabergoline was reintroduced in three out of 15 patients because the pituitary contacted the optic chiasm.…”

Cabergoline use for cushing’s disease during pregnancy: Mini review

“…A follow-up study up to 12 years of 223 children whose mothers took cabergoline in the first few weeks of gestation showed no abnormalities in their physical or mental development [25,26].…”