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Chapter 8 - Prolactin, Prolactinoma, and Pregnancy

from Section II - Hormones and Gestational Disorders

Published online by Cambridge University Press:  09 November 2022

By
Dominique Maiter  and
Philippe Chanson
Edited by
Felice Petraglia ,
Mariarosaria Di Tommaso  and
Federico Mecacci
Felice Petraglia
Affiliation:
Università degli Studi, Florence
Mariarosaria Di Tommaso
Affiliation:
Università degli Studi, Florence
Federico Mecacci
Affiliation:
Università degli Studi, Florence
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Summary

Prolactin (PRL) is a key player in normal physiology and pathophysiology of reproduction. Although not indispensable to achieve gestation in humans (as opposed to rodents), PRL is essential for the development of the mammary gland and for lactation. On the other hand, hyperprolactinemia is a frequent cause of infertility and needs to be corrected in a young woman who actively seeks pregnancy. Dopamine agonists (DA) represent the first-line treatment of prolactinomas, but transsphenoidal surgery may be considered in selected cases. Among DA, preference should be given to cabergoline over bromocriptine, due to its higher efficacy and better tolerance. Both drugs are safe to use during early gestation. In most cases, however, drug withdrawal is advised as soon as the pregnancy is confirmed. Symptomatic tumor growth is a rare event in microprolactinomas (2–3 percent) but more frequent in large macroprolactinomas without previous ablative therapy (15–20 percent). Symptomatic tumor enlargement will usually be successfully treated with resumption of the DA. Breastfeeding is not contra-indicated in women with a prolactinoma. In addition, pregnancy may have a beneficial effect on further endocrine outcome, inducing early remission of hyperprolactinemia in about 40 percent of these women. Data are much less robust in men in whom PRL concentrations are less prone to increase. The male reproductive axis is also less sensitive to the effects of hyperprolactinemia. Nevertheless, significant hyperprolactinemia in men may also cause hypogonadism and infertility and must be treated as in women.

Keywords

hyperprolactinaemiapituitary tumorscabergolinebromocriptinegestationinfertility
Type
Chapter
Information
Hormones and Pregnancy
Basic Science and Clinical Implications
 , pp. 73 - 86
Publisher: Cambridge University Press
Print publication year: 2022

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