According to the literature, the rate of significant tumor growth during pregnancy in patients with prolactinomas is 1.6%-4.5% for microadenomas and 15.6%-35.7% for macroadenomas. If a patient with macroadenoma has undergone surgical or radiation treatment prior to pregnancy, the chance of tumor growth during pregnancy decreases to 4.3%. Three questions are usually involved during pregnancy in patients with prolactinoma: 1) how to maintain menstruation and have a successful pregnancy; 2) what to do if the tumor grows rapidly during pregnancy; and 3) whether oral bromocriptine is safe for the fetus during pregnancy.
In patients with microadenoma, both surgery and bromocriptine can help to restore menstruation and achieve a successful pregnancy (80% vs. 85%). In addition, bromocriptine can be discontinued after pregnancy is confirmed because the chance of significant tumor growth during pregnancy is low. However, patients need to have regular visual field examinations during pregnancy to watch for new headache symptoms and vision changes. If any of the above occurs, MRI should be reviewed immediately and bromocriptine can be resumed after significant tumor growth is detected.
For patients with macroadenoma, especially those whose tumors are closely related to the optic cross and cavernous sinus, treatment measures such as surgery should be used to reduce the size of the tumor before considering pregnancy. For patients with macroadenoma who are already pregnant, the following treatment options can be used: 1. If the tumor continues to grow during pregnancy, the tumor can be removed by surgery after delivery if the fetal condition allows.
Bromocriptine is relatively safe to be taken before and during pregnancy. There is no evidence that bromocriptine can increase the risk of fetal malformation and miscarriage, but a longer period and more cases need to be observed to assess its safety and side effects. In principle, the use of bromocriptine should be minimized under the premise of tumor stability.
The choice of treatment plan during pregnancy for patients with prolactin adenoma requires an individualized treatment plan that takes into account the size of the tumor before treatment, the level of hormone secretion, whether the patient can tolerate the side effects of bromocriptine (e.g. bromocriptine causes nausea and vomiting and exacerbates vomiting in early pregnancy), the presence of visual field symptoms, whether the patient has received prior surgery and radiation therapy, and the general health status.