Managing prolactinoma during pregnancy

ABSTRACT

Prolactinomas are the most common pituitary tumors in pregnant women. We conducted this study on pregnant women with prolactinoma to determine their clinical symptoms and signs and eventual necessity to medical therapy. A descriptive study was performed on 85 pregnant women with prolactinoma. Patients were followed up by physical examination, imaging, and perimetry for diagnosis of visual field defect. If tumor was increased in size perimetry was performedin order to determine eventual visual field defect [VFD]. Patients with progressive visual field defect had absolute indication for trans sphenoidal surgery [TSS]. In other cases with progressive enlargement of adenoma size but without VFD bromocriptine was administered. Patients without increasing adenoma size were just followed up. In this study 72 patients [84%] had microadenomas, 7 patients [8%] had macroadenomas without previous medical or surgical therapy and 6 patients [7%] had macroadenomas with previous medical therapy with bromocriptine. Totally 20 patients [23%] had tumor enlargement during pregnancy and was symptomatic in 7 patients [8.2%]. There was significant difference between 3 groups according to incidence of symptomatic tumor enlargement [p<0.05]. Macroprolactinomas are more likely to enlarge during pregnancy than microprolactinomas. In our study conservative management was successfully done in all patients without surgery or medical therapy