Review of Clinical Recommendations on Prolactinoma and Pregnancy

ABSTRACT

Prolactinomas are the most common hormone-secreting pituitary adenomas. Prolactinomas account for nearly 30–40 percent of all the pituitary adenomas. Although it affects individuals over a wide age range, it is more common in 20–40-year-old female patients, who are in their reproductive age. Prolactinomas may cause hypogonadism, menstrual cycle dysfunction (oligomenorrhea or amenorrhea) and infertility (luteal phase abnormalities or anovulation) in premenopausal women. When pregnancy is excluded, hyperprolactinemia in approximately 10 to 20 percent of the patients results in amenorrhea. Women with untreated prolactinomas are generally unable to achieve pregnancy, as the hyperprolactinemia affects the pulsatility of gonadotropin-releasing hormone (GnRH) and diminishes follicle-stimulating hormone (FSH) as well as luteinizing hormone (LH) secretion. The sum of these effects induces amenorrhea, infertility, and hypogonadism, thereby posing difficulties in fertility. Therefore, in most women prolactinoma is diagnosed prior to conception. However, ovulation and fertility usually improve after proper diagnosis and treatment of prolactinoma. Therefore, during the surveillance of these patients, the onset of pregnancy is a common phenomenon. Management of these pregnancies may sometimes be challenging and require a multidisciplinary approach involving an endocrinologist, a gynecologist, a radiologist and an experienced neurosurgeon in order to achieve the best outcomes both for the patient as well the infant. In this report, the authors aim to summarize the consensus statements and the current guidelines for clinical practice.