Dopamine receptor agonist therapy during pregnancy may limit macroprolactinoma growth
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Nearly 20% of women with a macroprolactinoma experienced symptomatic tumor progression during pregnancy, suggesting that continued dopamine receptor agonist therapy during pregnancy may be warranted, according to findings from a retrospective study published in Clinical Endocrinology.
“For many years, pregnancy in a patient with a prolactinoma used to be considered as a potentially dangerous situation that could lead to tumor growth; some authors even suggested surgery before conception,” Bénédicte Decoudier, MD, a hospital practitioner in endocrinology at Centre Hospitalier Universitaire de Reims, Champagne-Ardenne, France, and colleagues wrote in the study background. “In actuality, it has been shown that microprolactinoma growth is the exception during pregnancy. Treatment for macroprolactinoma must be stopped during pregnancy, and they must be closely monitored. However, the management of dopamine receptor agonist-treated macroprolactinomas during pregnancy is different; there is no guideline, and the prognosis of those rare tumors remains unclear.”
In a retrospective, observational study, Decoudier and colleagues analyzed data from 46 women with macroprolactinomas (defined as an adenoma 10 mm at diagnosis) treated with a dopamine receptor agonist with 85 viable pregnancies. Regular obstetrical and endocrine follow-up were performed according to standard practices. Once pregnancy was diagnosed, stopping dopamine receptor agonist treatment was discussed on a case-by-case basis. During the pregnancies, only clinical follow-up was performed systematically. Visual field examinations and additional MRI scans were performed upon report of symptoms (headache, visual abnormalities) at each physician’s discretion. Adenoma progression during pregnancy was defined by the occurrence of symptoms and an increase in the size of the adenoma on MRI performed during pregnancy or immediately after delivery.
At diagnosis, mean size of pituitary adenomas were 17.9 mm and mean plasma prolactin level was 1,012.2 g/L.
Tumor growth-related symptoms were identified 12 times in nine patients (19.6%) including three cases of apoplexy. Restarting, changing and/or increasing dopamine receptor agonist treatment was effective in 10 cases. Researchers noted two cases of emergency surgery due to pituitary apoplexy.
Patients with tumor progression tended to present with larger tumors after initial treatment (mean, 9.9 mm vs. 5.9 mm; P = .0504) and before pregnancy (mean, 11.5 mm vs. 7.3 mm; P = .0671). The researchers noted that adenoma size at diagnosis did not seem to be a factor in tumor progression. Obstetrical outcomes were comparable to the general population.
“The risk of tumor growth seems to be greater when minimal adenoma size while on dopamine receptor agonist treatment or residual adenoma before pregnancy are larger,” the researchers wrote. “In those situations, maintaining dopamine receptor agonist therapy during pregnancy should be discussed.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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