Giant macroprolactinoma and pregnancy.

Prolactinomas are a common cause of gonadal dysfunction and infertility. We present the case of a 38-year-old woman with history of amenorrhea and infertility. At seven weeks of pregnancy she presented neuro-ophthalmologic complaints of headaches, diplopia, and right ptosis. The work-up study revealed an invasive pituitary macroadenoma with a maximum diameter of 9 cm and serum prolactin of 25,800 ng/mL (3-20). At 12 weeks, she was referred to the Endocrinology Department of the Coimbra University Hospital and started therapy with bromocriptine, initially 5 mg/day and then at crescent doses. Hyperprolactinemia was rapidly and drastically reduced to 254 ng/mL three weeks after taking bromocriptine 15 mg/day. Tumoral volume was reduced and there was improvement of III pair paresis. At 38 weeks, a male healthy baby was born. This is a relevant clinical case that illustrates the efficacy and safety of bromocriptine therapy during pregnancy, even in severe cases like this one.

Giant macroprolactinoma and pregnancy / Macroprolactinoma gigante e gravidez

Prolactinomas are a common cause of gonadal dysfunction and infertility. We present the case of a 38-year-old woman with history of amenorrhea and infertility. At seven weeks of pregnancy she presented neuro-ophthalmologic complaints of headaches, diplopia, and right ptosis. The work-up study revealed an invasive pituitary macroadenoma with a maximum diameter of 9 cm and serum prolactin of 25,800 ng/mL (3-20). At 12 weeks, she was referred to the Endocrinology Department of the Coimbra University Hospital and started therapy with bromocriptine, initially 5 mg/day and then at crescent doses. Hyperprolactinemia was rapidly and drastically reduced to 254 ng/mL three weeks after taking bromocriptine 15 mg/day. Tumoral volume was reduced and there was improvement of III pair paresis. At 38 weeks, a male healthy baby was born. This is a relevant clinical case that illustrates the efficacy and safety of bromocriptine therapy during pregnancy, even in severe cases like this one.

Os prolactinomas são uma causa comum de anovulação e infertilidade. Apresenta-se o caso de uma mulher de 38 anos com antecedentes de amenorreia e infertilidade. Por volta das sete semanas de gestação, iniciaram-se clínica neuro-oftalmológica de cefaleias hemicranianas, ptose palpebral direita e diplopia. O estudo complementar revela a presença de macroadenoma hipofisário com cerca de 9 cm de maior diâmetro, de crescimento invasivo e destrutivo associado à hiperprolactinemia de 25.800 ng/mL (3-20). Às 12 semanas, foi referenciada à consulta de Endocrinologia e iniciou terapêutica com bromocriptina 5 mg/dia em doses crescentes. A prolactina diminuiu drasticamente para 254 ng/mL três semanas após, sob 15 mg/dia de bromocriptina. O volume tumoral também foi significativamente reduzido nas suas diferentes extensões. Clinicamente, houve regressão da ptose palpebral e da restante sintomatologia neuro-oftalmológica. O parto ocorreu por via vaginal às 38 semanas, com recém-nascido saudável. Este caso clínico é relevante, ilustrando bem a eficácia e a inocuidade da terapêutica com bromocriptina durante toda a gravidez, mesmo em casos graves como este.