Macroprolactinoma: Diagnosis and Management in a Patient with Infertility

  • Souad Enakuaa
  • Lisa B. NachtigallEmail author


A 31-year-old who had a history of delayed puberty and then developed amenorrhea after stopping birth control pills was found to have a macroprolactinoma. Cabergoline therapy resulted in normalization of prolactin and menstrual periods within 6 months. The adenoma size decreased slowly, and the patient conceived. The dopamine agonist was withdrawn upon conception and restarted postpartum. Visual fields were monitored during the pregnancy which was uneventful. The diagnosis and therapy of hyperprolactinemia in a patient seeking fertility and the peri-partum management of prolactinoma during pregnancy are discussed.


Prolactinoma Prolactin Infertility Amenorrhea Macroadenoma 


  1. 1.
    Landolt AM. [Prolactin-producing pituitary adenomas as a cause of primary amenorrhea and their neurosurgical treatment]. Dtsch Med Wochenschr. 1983;108(8):298–301.Google Scholar
  2. 2.
    Ajmal A, Joffe H, Nachtigall LB. Psychotropic-induced hyperprolactinemia: a clinical review. Psychosomatics. 2014;55(1):29–36.Google Scholar
  3. 3.
    Shin SH, et al. Morphine can stimulate prolactin release independent of a dopaminergic mechanism. Can J Physiol Pharmacol. 1988;66(11):1381–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Gold MS, et al. Increase in serum prolactin by exogenous and endogenous opiates: evidence for antidopamine and antipsychotic effects. Am J Psychiatry. 1978;135(11):1415–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Glezer A, Bronstein MD. Prolactinomas, cabergoline, and pregnancy. Endocrine. 2014;47(1):64–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Melmed S, et al. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(2):273–88.CrossRefPubMedGoogle Scholar
  7. 7.
    Vilar L, Fleseriu M, Bronstein MD. Challenges and pitfalls in the diagnosis of hyperprolactinemia. Arq Bras Endocrinol Metabol. 2014;58(1):9–22.CrossRefPubMedGoogle Scholar
  8. 8.
    St-Jean E, Blain F, Comtois R. High prolactin levels may be missed by immunoradiometric assay in patients with macroprolactinomas. Clin Endocrinol (Oxf). 1996;44(3):305–9.CrossRefGoogle Scholar
  9. 9.
    Moraes AB, et al. Giant prolactinomas: the therapeutic approach. Clin Endocrinol (Oxf). 2013;79(4):447–56.CrossRefGoogle Scholar
  10. 10.
    Brue T, Castinetti F. The risks of overlooking the diagnosis of secreting pituitary adenomas. Orphanet J Rare Dis. 2016;11(1):135.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Faje A, Nachtigall L. Current treatment options for hyperprolactinemia. Expert Opin Pharmacother. 2013;14(12):1611–25.CrossRefPubMedGoogle Scholar
  12. 12.
    Biller BM, et al. Treatment of prolactin-secreting macroadenomas with the once-weekly dopamine agonist cabergoline. J Clin Endocrinol Metab. 1996;81(6):2338–43.PubMedGoogle Scholar
  13. 13.
    Molitch ME, et al. Bromocriptine as primary therapy for prolactin-secreting macroadenomas: results of a prospective multicenter study. J Clin Endocrinol Metab. 1985;60(4):698–705.CrossRefPubMedGoogle Scholar
  14. 14.
    Colao A, et al. Long-term and low-dose treatment with cabergoline induces macroprolactinoma shrinkage. J Clin Endocrinol Metab. 1997;82(11):3574–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Webster J, et al. A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline Comparative Study Group. N Engl J Med. 1994;331(14):904–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Donegan D, et al. Surgical outcomes of prolactinomas in recent era: results of a heterogenous group. Endocr Pract. 2017;23(1):37–45.CrossRefPubMedGoogle Scholar
  17. 17.
    Wilson CB. Surgical management of pituitary tumors. J Clin Endocrinol Metab. 1997;82(8):2381–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Pashtan I, Oh KS, Loeffler JS. Radiation therapy in the management of pituitary adenomas. Handb Clin Neurol. 2014;124:317–24.CrossRefPubMedGoogle Scholar
  19. 19.
    Ono M, et al. Individualized high-dose cabergoline therapy for hyperprolactinemic infertility in women with micro- and macroprolactinomas. J Clin Endocrinol Metab. 2010;95(6):2672–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Sarwar KN, et al. The prevalence and natural history of pituitary hemorrhage in prolactinoma. J Clin Endocrinol Metab. 2013;98(6):2362–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Watt A, Pobereskin L, Vaidya B. Pituitary apoplexy within a macroprolactinoma. Nat Clin Pract Endocrinol Metab. 2008;4(11):635–41.CrossRefPubMedGoogle Scholar
  22. 22.
    Briet C, et al. Pituitary apoplexy. Endocr Rev. 2015;36(6):622–45.CrossRefPubMedGoogle Scholar
  23. 23.
    Molitch ME. Endocrinology in pregnancy: management of the pregnant patient with a prolactinoma. Eur J Endocrinol. 2015;172(5):R205–13.CrossRefPubMedGoogle Scholar
  24. 24.
    Maiter D, Delgrange E. Therapy of endocrine disease: the challenges in managing giant prolactinomas. Eur J Endocrinol. 2014;170(6):R213–27.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Neuroendocrine UnitMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

Personalised recommendations