Prolactinomas and Pregnancy

  • Nina Rosa de Castro Musolino
  • Marcello Delano Bronstein
Part of the Endocrine Updates book series (ENDO, volume 15)

Abstract

Pituitary tumors correspond to 10 to 15% of intracranial tumors and its prevalence reaches as much as 27% in autopsy studies of the population (1). These tumors may be classified as microadenomas (diameter <10 mm) and macroadenomas (>10 mm), and could be enclosed, expansive and/or invasive (2). Prolactin-secreting adenomas (prolactinomas) are the most common of the pituitary-secreting tumors, and its prevalence is estimated at 500 cases/1,000,000 inhabitants (3). The incidence of prolactinomas is four times greater in women than in men; the microadenomalmacroadenoma ratio is approximately 3:1 in women. Since hyperprolactinemia is usually associated with anovulation, and prolactinomas present a greater incidence in the 3rd and 4th decades, these tumors are an important cause of infertility. Its treatment very frequently restores the hypothalamus-pituitary-ovary axis and it is expected to result in pregnancies. This chapter addresses the management of pregnancy in patients with prolactinomas submitted to different treatments, assessing their results and the deleterious effects on mother and fetus.

Keywords

Estrogen Dopamine Adenoma Assure Beach 

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References

  1. 1.
    Burrow, G.N., Wortzman, G., Rewcastle, H.B., Holgate, R.C., and Kovacs, K. 1981 Microadenomas of the pituitary and abnormal sellar tomograms in an unselected autopsy.N Engl J Med304:156PubMedCrossRefGoogle Scholar
  2. 2.
    Hardy, J. 1973 Transsphenoidal surgery of hypersecreting pituitary tumors. InDiagnosis and treatment of pituitary tumors.P.O. Kohler and G.T. Ross, editors. Amsterdam: Excerpta Medica, pp.179.Google Scholar
  3. 3.
    Miyai, K., Ichihara, K., Kondo, K., and Mori, S. 1986 Asymptomatic hyperprolactinaemia and prolactinoma in the general population-mass screening by paired assays of serum prolactin.Clin Endocrinol (Oxf)25:549–54CrossRefGoogle Scholar
  4. 4.
    Hardy, J. 1969 Transsphenoidal microsurgery of the normal and pathological pituitary.Clin Neurosurg16:185–217PubMedGoogle Scholar
  5. 5.
    Corenblum, B., Webster, B.R., Mortimer, C.B., et al. 1975 Possible anti-tumor effect of 2 patients with large prolactin-secreting pituitary adenomas.Clin Res23:61Google Scholar
  6. 6.
    Marino Jr, R. and Bronstein, M.D. 1988 The role of pituitary surgery in the treatment of prolactinomas. InClinical Endocrinology: Proceedings of the 18th Brazilian Congress of Endocrinology and MetabolismRio de Janeiro, Junho 12–17, 1988 R.M.R. Meireles, A. Machado, and L.C. Póvoa, editors. Amsterdam-New York-Oxford Excepta Medica,. pp:12–17.Google Scholar
  7. 7.
    Molitch, M.E. 1999 Medical treatment of prolactinomas.Endocrinol Metab Clin North Am28:143–69PubMedCrossRefGoogle Scholar
  8. 8.
    Berezin, M., Avidan, D., and Baron, E. 1991 Long-term pergolide treatment of hyperprolactinemic patients previously unsuccessfully treated with dipaminergic drugs.Isr J Med Sci27::375–9PubMedGoogle Scholar
  9. 9.
    Webster, J. 1996 A comparative review of the tolerability profiles of dopamine agonists in the treatment of hyperprolactinaemia and inhibition of lactation.Drug Saf14:228–38PubMedCrossRefGoogle Scholar
  10. 10.
    Musolino, N.R.C., Cunha Neto, M.B., and Bronstein, M.D. 2000 Cabergolina como alternativa no tratamento clinico de prolactinomas. Experiência na intolerância/resistência a bromocriptina.Arq Bras Endocrinol Metab44:139–43CrossRefGoogle Scholar
  11. 11.
    Colao, A., Di Sarno, A., Sarnacchiaro, F., Ferone, D., Di Renzo, G., Merola, B., Annunziato, L., and Lombardi, G. 1997 Prolactinomas resistant to standard dopamine agonists respond to chronic cabergoline treatment.J Clin Endocrinol Metab82:876–83CrossRefGoogle Scholar
  12. 12.
    Duranteau, L., Chanson, P., Lavoinne, A., Horlait, S., Lubetzki, J., and Kuhn, J. M. 1991 Effect of the new dopaminergic agonist CV 205–502 on plasma prolactin levels and tumour size in bromocriptine-resistant prolactinomas.Clin Endocrinol (Oxf)34:205–502CrossRefGoogle Scholar
  13. 13.
    Verhelst, J., Abs, R., Maiter, D., van der Bruel, A., Vandeweghe, M., Velkeniers, B., Mockel, J., Lamberigts, G., Petrossians, P., Coremans, P., Mahler, C., Stevenaert, A., Verlooy, J., Raftopoulos, C., and Beckers, A. 1999 Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients.J Clin Endocrinol Metab84:2518–22PubMedCrossRefGoogle Scholar
  14. 14.
    Cannavo, S., Curto, L., Squadrito, S., Almoto, B., Vieni, A., and Trimarchi, F. 1999 Cabergoline: a first-choice treatment in patients with previously untreated prolactinsecreting pituitary adenoma.J Endocrinol Invest22:354–9PubMedGoogle Scholar
  15. 15.
    Fahlbusch, R. and Buchfelder, M. 1985 Present status of neurosurgery in the treatment of prolactinomas.Neurosurg Rev8:195–205PubMedCrossRefGoogle Scholar
  16. 16.
    Soule, S.G., Farhi, J., Conway, G.S., Jacobs, H.S., and Powell, M. 1996 The outcome of hypophysectomy for prolactinomas in the era of dopamine agonist therapy.Clin Endocrinol (Oxf)44:711–6CrossRefGoogle Scholar
  17. 17.
    Turner, H.E., Adams, C.B., and Wass, J.A. 1999 Trans-sphenoidal surgery for microprolactinoma: an acceptable alternative to dopamine agonists ?Eur J Endocrinol140:43–7PubMedCrossRefGoogle Scholar
  18. 18.
    Bronstein, M.D., Musolino, N.R., Benabou, S., and Marino Jr, R. 1989 Cerebrospinal fluid rhinorrhea occurring in long-term bromocriptine treatment for macroprolactinomas.JSurg Neurol32:346–9CrossRefGoogle Scholar
  19. 19.
    Jalali, R., Brada, M., Perks, J.R., Warrington, A.P., Traish, D., Burchell, L., McNair, H., Thomas, D.G., Robinson, S., and Johnston, D.G. 2000 Stereotactic conformal radiotherapy for pituitary adenomas: technique and preliminary experience.Clin Endocrinol (Oxf)52:695–702CrossRefGoogle Scholar
  20. 20.
    Inoue,H.K.,Kohga,H.,Hirato, M.,Sasaki,T.,Shihara,J.,Shibazaki, T.,Ohye,C.,and Andou Y.1999 Pituitary adenomas treated by microsurgery with or without Gamma Knife surgery: experience in 122 cases.Stereotact Funct Neurosurg72:125–31CrossRefGoogle Scholar
  21. 21.
    Morange-Ramos, I., Regis, J., Dufor, H., Andrieu, J.M., Grisou, F., Jaquet, P., and Peragaut, J.C. 1998 Short-term endocrinological results after gamma knife surgery of pituitary adenomas.Stereotact Funct Neurosurg70:127–38PubMedCrossRefGoogle Scholar
  22. 22.
    Elster, A.D., Sanders, T.G., Vines, F.S., and Chen, M.Y. 1991 Size and shape of the pituitary gland during pregnancy and post partum: measurement with M R imaging.Radiology181:531–5PubMedGoogle Scholar
  23. 23.
    Dinc, H., Esen, F., Demirci, A., Sari, A., and Resit Gumele, H. 1998 Pituitary dimensions and volume measurements in pregnancy and post partum M R assessment.Acta Radiol39:64–9PubMedGoogle Scholar
  24. 24.
    Gonzalez, J.G., Elizondo, G., Saldriar, D., Nanez, H., Todd, L.E., and Vielarreal, J. Z. 1988 Pituitary gland growth during normal pregnancy: an in vivo study using magnetic resonance imaging.Am J Med85:217–20PubMedCrossRefGoogle Scholar
  25. 25.
    Scheithauer, B.W., Sano, T., Kovacs, K.T., Young Jr, W.F., Ryan, N., and Randall, R.V. 1990 The pituitary gland in pregnancy: a cliniopathologic and immunohistochemical study of 69 cases.Mayo Clin Proc65:461–74Google Scholar
  26. 26.
    Rigg, L.A., Lein, A., and Yen, S.S.C. 1977 Pattern of increase in circulating prolactin levels during human gestation.Am J Obstet Gynecol129: 454–6PubMedGoogle Scholar
  27. 27.
    Ferriani, R.A., Silva de Sá, M.F., and Lima Filho, E.C. 1986 A comparative study of longitudinal and cross-sectional changes in plasma levels of prolactin and estriol during normal pregnancy.Brazilian J Med Biol Res19:183–8Google Scholar
  28. 28.
    Zegher, F., Spitz, B., Van der Berghe, G., Lemmens, D., Vanweser, K., Keppens, K., and Bowers, C.Y. 1998 Postpartum hyperprolactinemia and hyporesponsiveness of growth hormone to GH-releasing peptide.J Clin Endocrinol Metab83:103–6PubMedCrossRefGoogle Scholar
  29. 29.
    Delvoye, P., Delogne-Desnoeck, J., and Robyn, C. 1980 Hyperprolactinaemia during prolonged lactation: evidence for anovulatory cycles and inadequate corpus luteum.Clin Endocrinol13:243–7Google Scholar
  30. 30.
    Magyar, D.M. and Marshall, J.R. 1978 Pituitary tumors and pregnancy.Am J Obstet Gynecol132:739–51PubMedGoogle Scholar
  31. 31.
    Gemzell, C. and Wang, C. F. 1979 Outcome of pregnancy in women with pituitary adenoma.Fertil Steril31:363–72PubMedGoogle Scholar
  32. 32.
    Krupp, P., and Monka, C. 1987 Bromocriptine in Pregnancy: Safety Aspects.Klin Wochenschr65:823–7PubMedCrossRefGoogle Scholar
  33. 33.
    Weil, C. 1986 The safety of bromocriptine in long-term use: a review of the literature.Curr Res Opin10:25–51CrossRefGoogle Scholar
  34. 34.
    Musolino, N., and Bronstein, M. 1999 Prolactinomas and pregnancy — Use of dopamine agonists: bromocriptine and cabergoline. Procedings of “The 6th International Pituitary Congress” Long Beach, California, p. 91 (Abstr.)Google Scholar
  35. 35.
    Molitch„ M.E. 1985 Pregnancy and the hyperprolactinemic woman.N Engl J Med312:1364–70PubMedCrossRefGoogle Scholar
  36. 36.
    Ferrer-Barriendos, J., Millet, A., and Lucas-Pinilla, E. 1981 Necrosis de un prolactinoma durante el embarazo.Rev Esp Obst Gin40:578–85Google Scholar
  37. 37.
    Holmgren, U., Bergstrand, G., Hagenfeldt, K., and Werner, S. 1986 Women with prolactinoma — effect of pregnancy and lactation on serum prolactin and on tumour growth.Acta Endocrinol (Copenh)111:452–9Google Scholar
  38. 38.
    Crosignani, P.G., Ferrari, C., Scarduelli, C., Picciotti, M.C., Caldara, R., Malinverni, A. 1981 Spontaneous and induced pregnancies in hyperprolactinemic women.Obstet Gynecol58:708–13PubMedGoogle Scholar
  39. 39.
    Shewchuk, A.B., Adamson, G.D., Lessard, P., and Ejrin, C. 1980 The effect of pregnancy on suspected pituitary adenomas after conservative management of ovulation defects associated with galactorrhea.Am J Obstet Gynecol136:659–66PubMedGoogle Scholar
  40. 40.
    Chil, D.F., Gordon, H., Mashiter, K., and Jopkin, G.F. 1975 Pregnancy, prolactin, and pituitary tumours.Br Med J4:87–9CrossRefGoogle Scholar
  41. 41.
    van Roon, E.., van der Vijver, J.C.M., Gerretsen, G., Hekster, R.E.M., and Wattendorff, R.A. 1981 Rapid regression of a suprasellar extending prolactinoma after bromocriptine treatment during pregnancy.Fertil and Steril36:173–7Google Scholar
  42. 42.
    Maeda, T., Ushiroyama, T., Okuda, K., Fujimoto, A., Ueki, M., and Sugimoto, O. 1983 Effective bromocriptine treatment of a pituitary macroadenoma during pregnancy.Obstet Gynecol61:117–20PubMedGoogle Scholar
  43. 43.
    Brodsky, J.B., Cohen, E.N., Brown, B.W. Jr, Wu, M.L., and Whitcher, C. 1980 Surgery during pregnancy and fetal outcome.Am J Obstet Gynecol138:1165–7PubMedGoogle Scholar
  44. 44.
    Bergh, T., Nillius, S.J., and Wide, L. 1978 Clinical course and outcome of pregnancies in amenorrhoeic women with hyperprolactinaemia and pituitary tumours.Br Med J1:875–880PubMedCrossRefGoogle Scholar
  45. 45.
    Tan, S.L., and Jacobs, H.S. 1986 Rapid regression through bromocriptine therapy of a suprasellar extending prolactinoma during pregnancy.Int J Gynaecol Obstet24:209–15PubMedCrossRefGoogle Scholar
  46. 46.
    Canales, E.S., Garcia, I.C., Ruiz, J.E., and Zarate, A. 1981 Bromocriptine as prophylactic therapy in prolactinoma during pregnancy.Fertil and Steril36:524–6Google Scholar
  47. 47.
    Konopka, P., Raymond, J.P., Merceron, R.E., and Seneze, J. Continuous administration of bromocriptine in the prevention of neurological complications in pregnant women with prolactinomas.Am J Obstet Gynecol146:935–8Google Scholar
  48. 48.
    Molitch, M.E. 1998 Pituitary diseases in pregnancy.Semin Perir - ftol22:457–70CrossRefGoogle Scholar
  49. 49.
    Morange, I., Barlier, A., Pellegrini, I., Brue, T., Enjalbert, A., and Jaquet, P. 1996 Prolactinomas resistant to bromocriptine: long-term efficacy of quinagolide and outcome of pregnancy.Eur J Endocrinol135:413–20PubMedCrossRefGoogle Scholar
  50. 50.
    Robert, E., Musatti L., Piscitelli, G., Ferrari, C. I. Pregnancy outcome after treatment with the ergot derivative, cabergoline.Reprod Toxico110: 333–7Google Scholar
  51. 51.
    Ciccarelli, E., Grottoli, S., Razzore, P., Gaia, D., Bertagna, A., Cirillo, S., Cammarota, T., Camanni, M., and Camanni, F. 1997 Long-term treatment with cabergoline, a new long-lasting ergoline derivative, in idiopathic or tumorous hyperprolactinaemia and outcome of drug-induced pregnancy.J Endocrinol Invest20:547–51PubMedGoogle Scholar
  52. 52.
    Zárate, A., Canales, E.S., Alger, M., and Forsbach, G. 1979 The effect of pregnancy and lactation on pituitary prolactin-secreting tumours.Acta Endocrinol (Copenh)92:407–12Google Scholar
  53. 53.
    Bronstein, M.D., Musolino, N.R., Cardim, C.S., and Marino Jr, R. 1988 Outcome of 52 pregnancies in hyperprolactinemic women.Rev Bras Ginecol Obstet10:175–178Google Scholar
  54. 54.
    Bronstein, M.D., Musolino, N.R., Cardim, C., Monteiro, M., Marino Jr, R. 1988 Repeatable depot-bromocriptine treatment for prolactinomas. InClinical Endocrinology: “Proceedings of the 18th Brazilian Congress of Endocrinology and Metabolism, Rio de Janeiro, Junho 12–17, 1988 R.M.R. Meireles, A. Machado, and L.C. Póvoa, editors. Amsterdam-New York-Oxford: Excepta Medica. 12–17.Google Scholar
  55. 55.
    Crosignani, P.G., Maffei, A.M., Severini, V., Cavioni, V, Maggioni, P., Testa, G.1992 Long-term effects of time, medical treatment and pregnancy in 176 hyperprolactinemic women.Eur J Obstet Gynecol Reprod Biol44:175–80PubMedCrossRefGoogle Scholar
  56. 56.
    Rjosk, H.K., Fahlbusch, R., and von Werder, K. 1982 Influence of pregnancies on prolactinomas.Acta Endocrino! (Copenh)100:337–46Google Scholar
  57. 57.
    Badawy, S.Z., Marziale, J.C., Rosenbaum, A.E., Chang, J.K., and Joy, S.E. 1997 The long-term effects of pregnancy and bromocriptine treatment on prolactinomas — the value of radiologic studies.Early Pregnancy3:306–11PubMedGoogle Scholar
  58. 58.
    Ahmed, M., al-Dossary, E., and Woodhouse, N.J. 1992 Macroprolactinomas with suprasellar extension: effect of bromocriptine withdrawal during one or more pregnancies.Fertil Steril58:492–7PubMedGoogle Scholar
  59. 59.
    Peillon, F., Racadot, J., Moussy, D., Vila-Porcile, E., Olivier, L., and Racadot, O. 1978 Prolactin-secreting adenomas. A correlative study of morphological and clinical dataIn Treatament of pituitary adenomas.R. Fahlbusch, and K. Von Werder, editors. Stuttgart: Thiemi. pp.1 14Google Scholar
  60. 60.
    Freeman, R., Wezenter, B., Silvestein, M., Kuo, D., Weiss, K.L., Kantrowitz, A.B., and Schubart, U.K. 1992 Pregnancy-associated subacute hemorrhage into a prolactinoma resulting in diabetes insipidus.Fertil Steril58:427–9PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Nina Rosa de Castro Musolino
    • 1
  • Marcello Delano Bronstein
    • 1
  1. 1.Neuroendocrine Unit, Hospital das ClinicasUniversity of S. Paulo Medical SchoolBrazil

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