Prolactinoma and pregnancy: From the wish of conception to lactation |
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| Affiliation: | 1. Service d’endocrinologie-nutrition, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne, France;2. Inserm U1173, université Versailles-Saint-Quentin, 2, avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France;3. Department of Endocrinology, Cochin University Hospital, AP–HP, French Adrenal Cancer Network COMETE-Cancer, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France;4. UMR 8104, institut Cochin, Paris, France;5. Medizinische Klinik IV, Klinikum der Universität München, Munich, Allemagne;1. Université Paris-Descartes Faculty of Medicine, 75006 Paris, France;2. Hypertension Unit, Assistance Publique–Hôpitaux de Paris, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France;1. Unité d’endocrinologie, maladies osseuses, génétique et gynécologie, hôpital des Enfants, CHU de Toulouse, TSA 70034, 31059 Toulouse cedex 09, France;2. Inserm UMR 1043 (Centre de physiopathologie de Toulouse-Purpan, CPTP), université de Toulouse-Paul-Sabatier, 31059 Toulouse, France;1. Institut national de la santé et de la recherche médicale, unité 1036, University Grenoble-Alpes, 38041 Grenoble, France;2. Commissariat à l’énergie atomique (CEA), BIG-Biology of Cancer and Infection, 38054 Grenoble, France;1. Service d’endocrinologie et des maladies de la reproduction, CHU de Bicêtre, AP–HP, 94275 Le Kremlin-Bicêtre, France;2. Faculté de médecine, université Paris-Saclay, université Paris-Sud, 94275 Le Kremlin-Bicêtre, France;3. Inserm U1185, Le Kremlin-Bicêtre, France |
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| Abstract: | Prolactinoma is a common cause of infertility in young women and treatment with dopamine agonists (DA) allows restoration of fertility in over 90% of the cases. Both bromocriptine and cabergoline have shown a good safety profile when administered during early pregnancy. In particular, data on exposure of the fetus or embryo to cabergoline during the first weeks of pregnancy have now been reported in more than 900 cases, and do indicate that cabergoline is safe in this context. There is no increase in the frequency of spontaneous miscarriage, premature delivery, multiple births or neonatal malformations, and follow-up studies of the children for up to 12 years after fetal exposure to cabergoline did not show any physical or developmental abnormalities. These women should therefore continue DA treatment until pregnancy has been initiated. Treatment discontinuation is recommended at that time in women with microprolactinoma or non-compressive macroprolactinoma. For microprolactinomas, the risk of symptomatic tumour enlargement during pregnancy is very low (2–3%). It is higher for macroprolactinomas (20–30%) and careful follow-up is advised, including MRI without contrast injection if symptoms or visual disturbances develop. If a symptomatic tumour enlargement does occur, reinitiation of the dopamine agonist (BRC or CAB) is indicated rather than surgery. Breast-feeding has no harmful effect on tumour growth and DA treatment, if still needed, may be postponed as long as breast-feeding is desired. Finally, about 40% of women with a microprolactinoma or an intermediate size macroprolactinoma may be in prolonged remission after one or more pregnancies. |
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| Keywords: | Prolactinoma Hyperprolactinaemia Cabergoline Bromocriptine Pregnancy Gestation Prolactinome Hyperprolactinémie Cabergoline Bromocriptine Grossesse Gestation |
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