NLM CIT. ID: 20114082
TITLE: Management of prolactinomas during pregnancy.
AUTHORS: Molitch ME
AUTHOR AFFILIATION:
Center for Endocrinology, Metabolism and Molecular Medicine,
Northwestern University Medical School, Chicago, IL 60611, USA.
PUBLICATION TYPES:
JOURNAL ARTICLE
LANGUAGES:
Eng
REGISTRY NUMBERS:
0 (Dopamine Agonists)
ABSTRACT:
Infertility is a common problem for women presenting with
hyperprolactinemia, and lowering of prolactin (PRL) levels to normal
or near normal is often necessary to permit ovulation. Dopamine
agonists are effective in a majority of women, with cabergoline
somewhat more effective than bromocriptine. Bromocriptine use by the
mother appears to be safe for the developing fetus when its use is
discontinued four to six weeks after conception. For women with
microadenomas, the subsequent risk of adenoma growth during pregnancy
appears to be 1% after discontinuing the drug, and symptomatic
follow-up each trimester appears to be reasonable in such patients.
For women with macroadenomas, bromocriptine may be discontinued after
diagnosis of pregnancy (23% risk of tumor enlargement) or continued
throughout pregnancy with monthly visual field testing.
Alternatively, prepregnancy debulking of the tumor may be undertaken
with appropriate follow-up (2.8% risk of tumor enlargement). Although
data are less extensive on cabergoline, preliminary evidence does not
suggest any increase in adverse fetal outcomes. As such, therapeutic
abortion is not warranted if pregnancy occurs during cabergoline
treatment. The drug appears reasonably safe for continued use.
Further accrual of safety data will clarify that issue.
NLM PUBMED CIT. ID:
10649822
SOURCE: J Reprod Med 1999 Dec;44(12 Suppl):1121-6
NLM CIT. ID: 99328136
TITLE: Cabergoline: a first-choice treatment in patients with previously
untreated prolactin-secreting pituitary adenoma.
AUTHORS: Cannavo S; Curto L; Squadrito S; Almoto B; Vieni A
Trimarchi F
AUTHOR AFFILIATION:
Cattedra di Endocrinologia, Universita di Messina, Italy.
salcan@mbox.vol.it
PUBLICATION TYPES:
CLINICAL TRIAL
JOURNAL ARTICLE
LANGUAGES:
Eng
REGISTRY NUMBERS:
0 (Antineoplastic Agents)
0 (Ergolines)
81409-90-7 (cabergoline)
9002-62-4 (Prolactin)
ABSTRACT:
Cabergoline (CAB) treatment is an effective, safe and well tolerated
approach for hyperprolactinemia. We investigated the efficacy of
24-month treatment with CAB in 37 patients with previously untreated
PRL-secreting pituitary adenoma and evaluated the hormonal and
neuroradiological changes after the discontinuation of long-term
therapy. Eleven patients with macroprolactinoma (1M/10F) and 26 with
microprolactinoma (4M/22F) started treatment taking 0.25 mg CAB twice
a week for 4 weeks. The dose was increased stepwise in 0.5 mg
increments until reaching lowest maximally effective and tolerated
dose. CAB was withdrawn before the end of the study in 6 women who
became pregnant and in one patient who showed a slight increase of
the macroadenoma at MRI. During treatment, PRL levels decreased
significantly in macro (11.1+/-1.1 vs 407.8+/-98.3 microg/l,
p<0.001) and microprolactinomas (11.1+/-1.6 vs 193.8+/-23.4
microg/l, p<0.05) and normalized in all macro and in 23/26
microprolactinomas. In 3 cases PRL levels decreased but did not
normalize because the appearance of side effects, such as nausea or
hypotension, prevented the increase of the dose of CAB. The effective
dose of drug correlated significantly with basal serum PRL levels
(p<0.05) and with the pituitary tumor size (p<0.05). A
significant decrease of the mean adenoma size was evident for macro
(6.9+/-1.8 vs 16.0+/-1.8 mm, p<0.001) and microprolactinomas
(3.0+/-0.5 vs 6.5+/-0.4 mm, p<0.001) at MRI. The tumor disappeared
in 4 macroadenomas and in 11 microadenomas after 12 months of
treatment. CAB withdrawal was followed by serum PRL increase in 13
cases after 3 months, in 6 after 6 months, in 2 after 9 months, and
in one patient at the 12th month. Five patients showed
normoprolactinemia with negative MRI after one year. Regular menses
were restored in 7/10 macroprolactinomas and in all oligo-amenorrhoic
patients with microadenoma; serum testosterone levels normalized in
2/3 hypogonadic men. Five out of 6 women become pregnant and had
uneventful pregnancies which resulted in deliveries of normal babies.
In conclusion, this study confirms the effectiveness and safety of
CAB for patients with PRL-secreting pituitary adenoma and suggests
that it can be considered a first choice treatment.
NLM PUBMED CIT. ID:
10401709
SOURCE: J Endocrinol Invest 1999 May;22(5):354-9
UI - 99186001
AU - Badawy SZ; Marziale JC; Rosenbaum AE; Chang JK; Joy SE
TI - The long-term effects of pregnancy and bromocriptine treatment on
prolactinomas--the value of radiologic studies.
SO - Early Pregnancy 1997 Dec;3(4):306-11
AD - Department of Obstetrics and Gynecology, State University of New
York Health Science Center at Syracuse 13210, USA.
OBJECTIVE: To evaluate the long-term effects of pregnancy and
bromocriptine treatment on prolactin-secreting pituitary tumors in women
undergoing infertility treatment for prolactinomas. METHODS: The records
of 17 patients with prolactinomas were reviewed. Data regarding age,
prepregnancy baseline and postpartum serum prolactin levels, and
radiologic studies including CT or MRI were assessed. 16 patients were
treated with bromocriptine before achieving pregnancy. Bromocriptine
therapy was resumed after delivery for the duration of 1 to 14 years.
RESULTS: 45% of pregnancies did not affect the size of prolactinomas, 27%
of pregnancies showed a decrease in size of prolactinomas or radiologic
evidence of resolution of the tumor and 27% of pregnancies demonstrated
radiologic increase in the size of prolactinomas. CONCLUSIONS: It is safe
for patients with prolactinomas to achieve pregnancy following
bromocriptine treatment. Pregnancy may lead to a slight decrease in the
size of prolactinomas, increase in size, no change, and in some cases,
complete resolution. There were no visual field changes during the
pregnancies. Pregnancy and long-term bromocriptine treatment may be
helpful in reduction of the size of the tumor.
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