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Having pituatary microadenoma, on cabbergolin dose, done MRI. Can i go for pregnancy?

hi doc, i am having pituatary microadenoma 7.5x 5.5mm. can i go for pregnancy. i am on cabbergolin dose of 0.5mg per week for last 1 year. i am 32 years old. also is there any risk if i concieve. have done my MRI on 6 feb 2013 before 9 months my adenoma was 1.1x 1.2x1.0cm. also my prolactin is below normal levels. pls advice
Asked On : Mon, 25 Feb 2013
Answers:  2 Views:  68
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OBGYN 's  Response
Mar 2013
Thank you for your query.

Fertility is often impaired in women with pre-existing pituitary disease. Advances in ovulation induction or medical and surgical therapy has allowed pregnancy to occur in many of these women. Prolactinomas that symptomatically enlarge during pregnancy are uncommon. Symptoms suggestive of growth are headache, visual field changes, and diabetes insipidus.

Re-initiation of bromocriptine is the preferred treatment for pregnant women with prolactinomas who become symptomatic. Most cases quickly show a regression of symptoms (headache) and signs (visual field changes) of tumor enlargement, and the bromocriptine re-administration to date appears to be safe. Given the risks of fetal loss associated with surgery, restarting bromocriptine may be preferable if tumor enlargement occurs. Transsphenoidal surgery or delivery (if pregnancy is advanced enough) is an alternative if the patient does not respond to bromocriptine or if further visual deterioration occurs.

Breastfeeding is safe and has not been associated with the growth of underlying prolactinomas.

Take care.
Answered: Tue, 26 Feb 2013
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Critical Care Specialist Dr. Arshad Hussain's  Response
Dear patient, while considering a patient of prolactin secreting pituitary microadenoma (microprolactinoma) on dopaminergic agonist drugs like bromocriptine or cabbergolin , becomming pregnant , two issues need to be addressed
1. effect of pregnancy on prolactinoma
2. safety of the dopaminergic agonist drug during pregnancy
Regarding the first one i.e effect of pregnancy on prolactinoma , it is known that pregnancy causes an increase in the size of normal pituitary gland by about 30% and this increase in size occurs in all directions, gland height may increase up to 12 mm but it usually never crosses 26mm. However chances of clinically significant enlargement of a pituitary microprolactinoma during pregnancy are only 1.3% if dopamine agonists are discontinued and the chances are lesser especially if the tumour has regressed with prior dopamine agonistic therapy. Therefore patients with microprolactinomas are not diccouraged from becomming pregnant .
Regarding the second issue i.e safety of dopamine agonists during pregnancy on foetal well being, cabbergolin being a newer drug ,its safety profile is not clearly established regarding its propensity to cause spontaneous abortion ,ectopic pregnancy,trophoblastic disease, multiple pregnancies or foetal malformations, where as the safety profile of bromocriptine is well established during pregnancy except for first 3 to 4 weeks. There fore bromocriptine is considered the therpy of choice for microprolactinoma during pregnany.
The standard approach for a patient of microprolactinoma who wants to become pregnant is to start the patient on bromocriptine to allow the ovulation to occur,encourage unprotacted contact with the husband, and watch for the pregnancy to occur, once pregnancy is confirmed, hold bromocriptine and keep the patient under observation for any symptoms of tumour enlargement like headache,blurring of vision ,excessive urination due to diabetes insipidus and if these symptoms occur,bromocriptine should be immediately reinstituted and MRI brain with out contrast should be done to access the pituitary gland. Generally regression occurs with bromocriptine reinstitution with improvement of symptoms except in few rare cases where trans nasal trans sphenoidal hypophysectomy may be required but the surgery carries the risk of foetal loss There fore i feel that you can go ahead and plan for pregnancy becoz you had a microprolactinoma that had regressed with dopamine agonistic drug (cabbergoline) but for this challange you need to be under close monitaring and supervision of your endocrinologist , lets hope for the best and be prepared for the worst .
Answered: Tue, 26 Feb 2013
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