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Issue 135 Spring 2020

Endocrinologist > Spring 2020 > Hot topics

Evolution of macroprolactinomas during pregnancy

| Hot topics

Management of any endocrine disorder during pregnancy brings additional challenges, as there is the safety of two people to consider, as well as the impact of the endocrine conditions on the disease process. Barraud and colleagues have described 85 pregnancies in women with macroprolactinoma, in a multicentre, retrospective study which provides useful information.

Adenoma size was >20mm in 30.4% of the patients. Progression was defined by relevant clinical symptoms. Patients were followed clinically with visual field assessment. Twelve cases of tumour growth occurred (14.1%) in nine patients (19.6%); three of these had clinically significant tumour growth and two required surgery during pregnancy due to tumour growth threatening vision. Dopamine receptor agonist (DA) was discontinued in 64% had, with the remainder continuing on DA. No pre-pregnancy features predicted increase in size of the macroprolactinoma during pregnancy.

There is no accepted clinical guidance, and whilst the literature says to discontinue DA during pregnancy, there is the view that DA should be continued for macroprolactinoma. The current paper adds to our knowledge of macroprolactinoma during pregnancy and reminds us that careful observation is needed to pick up those patients whose tumours are enlarging.

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