Semin Perinatol. 1998 Dec;22(6):457-70. Related Articles, Links

Pituitary diseases in pregnancy.

Molitch ME.Center for Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Medical School, Chicago, IL 60611, USA.

Pituitary adenomas are the most common pituitary disorder affecting pregnancy, and prolactinomas are the mostcommon of the hormone-secreting pituitary adenomas. Hyperprolactinemia must be corrected to allow ovulationand fertility. Bromocriptine has been shown to be safe for use during early gestation. There is less than a 2% risk of microprolactinoma enlargement during pregnancy but a greater than 15% risk of symptomatic enlargementof a macroprolactinoma. Treatment options for patients with macroadenomas include stopping bromocriptine whenpregnancy is diagnosed and reinstituting with tumor enlargement, continuous bromocriptine throughout pregnancy, and prepregnancy tumor debulking by surgery. The diagnosis of acromegaly may be difficult to make duringpregnancy and relies, in part, on the persistence of the normal pulsatile secretion of growth hormone and loss ofthis secretory characteristic with a tumor. The growth hormone oversecretion may exacerbate tendencies togestational diabetes, fluid retention, and hypertension. Treatment for acromegaly and other tumors generallymay be deferred until after delivery. There are rare reports of enlargement of clinically nonfunctioning andgrowth hormone secreting tumors during pregnancy, and surveillance is needed. Tumors may need to be differentiated from lymphocytic hypophysitis. Patients with chronic hypopituitarism usually will need treatmentwith gonadotropins or pulsatile GnRH to become pregnant and may need increased steroid coverage during labor and delivery. Hypopituitarism developing during pregnancy is usually caused by lymphocytic hypophysitis andusually also will require steroid replacement therapy. Hypopituitarism arising postpartum may be caused by eitherlymphocytic hypophysitis or Sheehan's syndrome, and the latter may present as an acute or chronic syndrome. Borderline diabetes insipidus may manifest during pregnancy because of increased vasopressin degradation causedby markedly increased levels of placental vasopressinase. Treatment with desmopressin usually is satisfactory. Patients presenting with either anterior or posterior pituitary insufficiency in the peripartum period shouldalways be evaluated for function of the other portion of the pituitary.

Semin Perinatol. 1998 Dec;22(6):457-70. Related Articles, Links

Pituitary diseases in pregnancy.

Molitch ME.Center for Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Medical School, Chicago, IL 60611, USA.

Pituitary adenomas are the most common pituitary disorder affecting pregnancy, and prolactinomas are the mostcommon of the hormone-secreting pituitary adenomas. Hyperprolactinemia must be corrected to allow ovulationand fertility. Bromocriptine has been shown to be safe for use during early gestation. There is less than a 2% risk of microprolactinoma enlargement during pregnancy but a greater than 15% risk of symptomatic enlargementof a macroprolactinoma. Treatment options for patients with macroadenomas include stopping bromocriptine whenpregnancy is diagnosed and reinstituting with tumor enlargement, continuous bromocriptine throughout pregnancy, and prepregnancy tumor debulking by surgery. The diagnosis of acromegaly may be difficult to make duringpregnancy and relies, in part, on the persistence of the normal pulsatile secretion of growth hormone and loss ofthis secretory characteristic with a tumor. The growth hormone oversecretion may exacerbate tendencies togestational diabetes, fluid retention, and hypertension. Treatment for acromegaly and other tumors generallymay be deferred until after delivery. There are rare reports of enlargement of clinically nonfunctioning andgrowth hormone secreting tumors during pregnancy, and surveillance is needed. Tumors may need to be differentiated from lymphocytic hypophysitis. Patients with chronic hypopituitarism usually will need treatmentwith gonadotropins or pulsatile GnRH to become pregnant and may need increased steroid coverage during labor and delivery. Hypopituitarism developing during pregnancy is usually caused by lymphocytic hypophysitis andusually also will require steroid replacement therapy. Hypopituitarism arising postpartum may be caused by eitherlymphocytic hypophysitis or Sheehan's syndrome, and the latter may present as an acute or chronic syndrome. Borderline diabetes insipidus may manifest during pregnancy because of increased vasopressin degradation causedby markedly increased levels of placental vasopressinase. Treatment with desmopressin usually is satisfactory. Patients presenting with either anterior or posterior pituitary insufficiency in the peripartum period shouldalways be evaluated for function of the other portion of the pituitary.

El 2% de los microadenomas crecendurante el embarazo

El 15% de los macroadenomaslo hacen

Semin Perinatol. 1998 Dec;22(6):457-70. Related Articles, Links

Pituitary diseases in pregnancy.

Molitch ME.Center for Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Medical School, Chicago, IL 60611, USA.

Pituitary adenomas are the most common pituitary disorder affecting pregnancy, and prolactinomas are the mostcommon of the hormone-secreting pituitary adenomas. Hyperprolactinemia must be corrected to allow ovulationand fertility. Bromocriptine has been shown to be safe for use during early gestation. There is less than a 2% risk of microprolactinoma enlargement during pregnancy but a greater than 15% risk of symptomatic enlargementof a macroprolactinoma. Treatment options for patients with macroadenomas include stopping bromocriptine whenpregnancy is diagnosed and reinstituting with tumor enlargement, continuous bromocriptine throughout pregnancy, and prepregnancy tumor debulking by surgery. The diagnosis of acromegaly may be difficult to make duringpregnancy and relies, in part, on the persistence of the normal pulsatile secretion of growth hormone and loss ofthis secretory characteristic with a tumor. The growth hormone oversecretion may exacerbate tendencies togestational diabetes, fluid retention, and hypertension. Treatment for acromegaly and other tumors generallymay be deferred until after delivery. There are rare reports of enlargement of clinically nonfunctioning andgrowth hormone secreting tumors during pregnancy, and surveillance is needed. Tumors may need to be differentiated from lymphocytic hypophysitis. Patients with chronic hypopituitarism usually will need treatmentwith gonadotropins or pulsatile GnRH to become pregnant and may need increased steroid coverage during labor and delivery. Hypopituitarism developing during pregnancy is usually caused by lymphocytic hypophysitis andusually also will require steroid replacement therapy. Hypopituitarism arising postpartum may be caused by eitherlymphocytic hypophysitis or Sheehan's syndrome, and the latter may present as an acute or chronic syndrome. Borderline diabetes insipidus may manifest during pregnancy because of increased vasopressin degradation causedby markedly increased levels of placental vasopressinase. Treatment with desmopressin usually is satisfactory. Patients presenting with either anterior or posterior pituitary insufficiency in the peripartum period shouldalways be evaluated for function of the other portion of the pituitary.

El 2% de los microadenomas crecendurante el embarazo

El 15% de los macroadenomaslo hacen

A veces, durante el embarazo esnecesario proseguir el tratamiento

con bromocriptina o recurrira la cirugía hipofisaria

: Pituitary. 2002;5(2):99-107. Related Articles, Links

Medical management of pituitary adenomas: the special case ofmanagement of the pregnant woman.

Bronstein MD, Salgado LR, de Castro Musolino NR.Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of S. Paulo Medical School, SP, Brazil. mdbronstein@uol.com.br

The development of efficacious surgical and medical therapies for pituitary adenomas as well as the improvementof hormone therapy for ovulation induction has made pregnancy possible for women harboring pituitary tumors. However, gestational risks due to the possibility of tumor growth during pregnancy, mainly in women withmacroadenomas, raise a concern. Bromocriptine has a well-established role for prolactinoma treatment beforeand during pregnancy, even when a symptomatic tumor increase occurs. It can also be used in acromegaly, despite its poorer results. Somatostatin analogs have been used in acromegaly even during pregnancy withuneventful outcomes, but their safety in pregnancy is not well established, yet. The largest experience withmedical treatment for Cushing's disease during pregnancy involves metyrapone, a steroidogenesis inhibitor, without descriptions of congenital abnormalities. Concerning clinically non-functioning pituitary tumors, ovulationinduction or even in vitro fertilization are frequently needed. The purpose of this review is to provide an updateon therapeutic strategies to restore fertility as well as gestational and post-gestational management of patientswith pituitary adenomas, focusing mainly on the role of medical treatment for different tumor types.

PMID: 12675507 [PubMed - in process]

: Pituitary. 2002;5(2):99-107. Related Articles, Links

Medical management of pituitary adenomas: the special case ofmanagement of the pregnant woman.

Bronstein MD, Salgado LR, de Castro Musolino NR.Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of S. Paulo Medical School, SP, Brazil. mdbronstein@uol.com.br

The development of efficacious surgical and medical therapies for pituitary adenomas as well as the improvementof hormone therapy for ovulation induction has made pregnancy possible for women harboring pituitary tumors. However, gestational risks due to the possibility of tumor growth during pregnancy, mainly in women withmacroadenomas, raise a concern. Bromocriptine has a well-established role for prolactinoma treatment beforeand during pregnancy, even when a symptomatic tumor increase occurs. It can also be used in acromegaly, despite its poorer results. Somatostatin analogs have been used in acromegaly even during pregnancy withuneventful outcomes, but their safety in pregnancy is not well established, yet. The largest experience withmedical treatment for Cushing's disease during pregnancy involves metyrapone, a steroidogenesis inhibitor, without descriptions of congenital abnormalities. Concerning clinically non-functioning pituitary tumors, ovulationinduction or even in vitro fertilization are frequently needed. The purpose of this review is to provide an updateon therapeutic strategies to restore fertility as well as gestational and post-gestational management of patientswith pituitary adenomas, focusing mainly on the role of medical treatment for different tumor types.

PMID: 12675507 [PubMed - in process]

La bromocriptina ha demostrado su utilidaddurante el embarazocuando es necesaria

Aún para el tratamiento deadenomas que crezcan

a lo largo de la gestación

: Neurochirurgie. 2000 Apr;46(2):88-94. Related Articles, Links

[Pituitary disorders in pregnancy]

Jan M, Destrieux C.Service de Neurochirurgie, CHU Bretonneau, 37044 Tours Cedex 01.

During pregnancy there is a normal increase in the volume of the anterior pituitary as demonstrated by MRI andhormone secretions which increase (PRL) or decrease (FSH, LH). During pregnancy pituitary adenomas, especiallyprolactinomas, may evolve as in non-pregnant women (microadenomas) or differently (macroadenomas). In 35 % of cases macroprolactinomas worsen during pregnancy making their medico-surgical management mandatory prior to pregnancy. Inversely, pregnancy occurring in a subject with a microprolactinoma never induces severe local complications so such tumors may be managed surgically or medically. Surgery should be performed foracromegaly or Cushing's disease before or early in pregnancy. Subacute pituitary apoplexy (intratumoralhemorrhage) occurs in about 10 to 15 % of adenomas but, generally speaking, clinical symptoms remain mild in pregnant women. Lymphocytic hypophysitis occurs at the end of pregnancy, or during the post-partum period. The association of complete pan-hypopituitarism and hypersignal on MRI examination may mimic hypophysealapoplexy and could lead to and inappropriate surgical procedure.

: Neurochirurgie. 2000 Apr;46(2):88-94. Related Articles, Links

[Pituitary disorders in pregnancy]

Jan M, Destrieux C.Service de Neurochirurgie, CHU Bretonneau, 37044 Tours Cedex 01.

During pregnancy there is a normal increase in the volume of the anterior pituitary as demonstrated by MRI andhormone secretions which increase (PRL) or decrease (FSH, LH). During pregnancy pituitary adenomas, especiallyprolactinomas, may evolve as in non-pregnant women (microadenomas) or differently (macroadenomas). In 35 % of cases macroprolactinomas worsen during pregnancy making their medico-surgical management mandatory prior to pregnancy. Inversely, pregnancy occurring in a subject with a microprolactinoma never induces severe local complications so such tumors may be managed surgically or medically. Surgery should be performed foracromegaly or Cushing's disease before or early in pregnancy. Subacute pituitary apoplexy (intratumoralhemorrhage) occurs in about 10 to 15 % of adenomas but, generally speaking, clinical symptoms remain mild in pregnant women. Lymphocytic hypophysitis occurs at the end of pregnancy, or during the post-partum period. The association of complete pan-hypopituitarism and hypersignal on MRI examination may mimic hypophysealapoplexy and could lead to and inappropriate surgical procedure.

El 35% de los macroadenomasempeoran durante el

embarazo

Por ello debe realizarse su completo tratamiento

médico/quirúrgico antes dela gestación

: Neurochirurgie. 2000 Apr;46(2):88-94. Related Articles, Links

[Pituitary disorders in pregnancy]

Jan M, Destrieux C.Service de Neurochirurgie, CHU Bretonneau, 37044 Tours Cedex 01.

During pregnancy there is a normal increase in the volume of the anterior pituitary as demonstrated by MRI andhormone secretions which increase (PRL) or decrease (FSH, LH). During pregnancy pituitary adenomas, especiallyprolactinomas, may evolve as in non-pregnant women (microadenomas) or differently (macroadenomas). In 35 % of cases macroprolactinomas worsen during pregnancy making their medico-surgical management mandatory prior to pregnancy. Inversely, pregnancy occurring in a subject with a microprolactinoma never induces severe local complications so such tumors may be managed surgically or medically. Surgery should be performed foracromegaly or Cushing's disease before or early in pregnancy. Subacute pituitary apoplexy (intratumoralhemorrhage) occurs in about 10 to 15 % of adenomas but, generally speaking, clinical symptoms remain mild in pregnant women. Lymphocytic hypophysitis occurs at the end of pregnancy, or during the post-partum period. The association of complete pan-hypopituitarism and hypersignal on MRI examination may mimic hypophysealapoplexy and could lead to and inappropriate surgical procedure.

El 35% de los macroadenomasempeoran durante el

embarazo

Por ello debe realizarse su completo tratamiento

médico/quirúrgico antes dela gestación

Por el contrario, los microadenomasrara vez son un problema

durante el embarazo

: Gynecol Endocrinol. 1996 Apr;10(2):91-4. Related Articles, Links

Relative resistance of a macroprolactinoma to bromocriptine therapy duringpregnancy.

Shanis BS, Check JH.Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey, Robert WoodJohnson Medical School at Camden, Cooper Hospital/University Medical Center, USA.

A woman presented with a pituitary macroadenoma with extensive suprasellar extension. Her initial response tobromocriptine therapy was good, allowing subsequent trans-sphenoidal surgical treatment. The tumor grew duringpregnancy despite continued bromocriptine therapy, but it returned to prepregnancy size postdelivery. Therehave been conflicting reports regarding the growth of pituitary tumors in pregnancy. Most recognize that some growth may occur, but only a small percentage of patients are reported to become symptomatic from thegrowth. Resistance to bromocriptine has been reported in non-pregnant patients. Patients who have had surgeryor radiation therapy and did not receive bromocriptine treatment during pregnancy have been reported to havesymptomatic growth of their residual tumor. This case demonstrates an unusual tumor that became resistant tobromocriptine during pregnancy, but whose sensitivity to the drug returned postdelivery.

PMID: 8701792 [PubMed - indexed for MEDLINE]

: Gynecol Endocrinol. 1996 Apr;10(2):91-4. Related Articles, Links

Relative resistance of a macroprolactinoma to bromocriptine therapy duringpregnancy.

Shanis BS, Check JH.Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey, Robert WoodJohnson Medical School at Camden, Cooper Hospital/University Medical Center, USA.

A woman presented with a pituitary macroadenoma with extensive suprasellar extension. Her initial response tobromocriptine therapy was good, allowing subsequent trans-sphenoidal surgical treatment. The tumor grew duringpregnancy despite continued bromocriptine therapy, but it returned to prepregnancy size postdelivery. Therehave been conflicting reports regarding the growth of pituitary tumors in pregnancy. Most recognize that some growth may occur, but only a small percentage of patients are reported to become symptomatic from thegrowth. Resistance to bromocriptine has been reported in non-pregnant patients. Patients who have had surgeryor radiation therapy and did not receive bromocriptine treatment during pregnancy have been reported to havesymptomatic growth of their residual tumor. This case demonstrates an unusual tumor that became resistant tobromocriptine during pregnancy, but whose sensitivity to the drug returned postdelivery.

PMID: 8701792 [PubMed - indexed for MEDLINE]

Se ha descripto la resistencia a labromocriptina fuera del

embarazo

Se describe el caso de una paciente que recibió tratamiento médico

y quirurgico por un macroprolactinoma previo al

emabaro

: Gynecol Endocrinol. 1996 Apr;10(2):91-4. Related Articles, Links

Relative resistance of a macroprolactinoma to bromocriptine therapy duringpregnancy.

Shanis BS, Check JH.Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey, Robert WoodJohnson Medical School at Camden, Cooper Hospital/University Medical Center, USA.

A woman presented with a pituitary macroadenoma with extensive suprasellar extension. Her initial response tobromocriptine therapy was good, allowing subsequent trans-sphenoidal surgical treatment. The tumor grew duringpregnancy despite continued bromocriptine therapy, but it returned to prepregnancy size postdelivery. Therehave been conflicting reports regarding the growth of pituitary tumors in pregnancy. Most recognize that some growth may occur, but only a small percentage of patients are reported to become symptomatic from thegrowth. Resistance to bromocriptine has been reported in non-pregnant patients. Patients who have had surgeryor radiation therapy and did not receive bromocriptine treatment during pregnancy have been reported to havesymptomatic growth of their residual tumor. This case demonstrates an unusual tumor that became resistant tobromocriptine during pregnancy, but whose sensitivity to the drug returned postdelivery.

PMID: 8701792 [PubMed - indexed for MEDLINE]

Se ha descripto la resistencia a labromocriptina fuera del

embarazo

Se describe el caso de una paciente que recibió tratamiento médico

y quirurgico por un macroprolactinoma previo al

emabaro

El tumor residual creció nuevamente durante el embarazo demostrando

refringencia al tratamientocontinuado con bromocriptina

durante la gestacion

: Gynecol Endocrinol. 1996 Apr;10(2):91-4. Related Articles, Links

Relative resistance of a macroprolactinoma to bromocriptine therapy duringpregnancy.

Shanis BS, Check JH.Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey, Robert WoodJohnson Medical School at Camden, Cooper Hospital/University Medical Center, USA.

A woman presented with a pituitary macroadenoma with extensive suprasellar extension. Her initial response tobromocriptine therapy was good, allowing subsequent trans-sphenoidal surgical treatment. The tumor grew duringpregnancy despite continued bromocriptine therapy, but it returned to prepregnancy size postdelivery. Therehave been conflicting reports regarding the growth of pituitary tumors in pregnancy. Most recognize that some growth may occur, but only a small percentage of patients are reported to become symptomatic from thegrowth. Resistance to bromocriptine has been reported in non-pregnant patients. Patients who have had surgeryor radiation therapy and did not receive bromocriptine treatment during pregnancy have been reported to havesymptomatic growth of their residual tumor. This case demonstrates an unusual tumor that became resistant tobromocriptine during pregnancy, but whose sensitivity to the drug returned postdelivery.

PMID: 8701792 [PubMed - indexed for MEDLINE]

Se ha descripto la resistencia a labromocriptina fuera del

embarazo

Se describe el caso de una paciente que recibió tratamiento médico

y quirurgico por un macroprolactinoma previo al

emabaro

El tumor residual creció nuevamente durante el embarazo demostrando

refringencia al tratamientocontinuado con bromocriptina

durante la gestacion

Al concluír la misma el tumorse hizo nuevamente

sensible a la bromocriptina

Pituitary. 2001 Aug;4(3):179-85. Related Articles, Links

Successful treatment of a large macroprolactinoma with cabergolineduring pregnancy.

Liu C, Tyrrell JB.Department of Medicine, University of California, San Francisco, 94143-0326, USA. cliu@itsa.ucsf.edu

We report a pregnant woman with a large macroprolactinoma successfully treated with cabergoline after a suboptimal response to bromocriptine. A 7 week pregnant woman with a history of a prolactinoma presentedto the endocrine clinic with the complaints of headaches and nausea. She had a prolactin level of 65 microg/L 1 1/2 weeks following her last menstrual period. Bromocriptine was discontinued at 6 weeks gestation whenpregnancy was confirmed. A PRL concentration was 1899 microg/L (non-pregnant normal range 1.39-24.20 microg/L, the mean peak levels during pregnancy reported from the literature are 200-210 microg/L) at 7 weeks gestation, and a repeat was 2197 microg/L. An MRI showed a 3 x 2.2 x 2.5 cm seller mass abutting theoptic chiasm and displacing the optic nerves superiorly; the visual field testing was normal. Bromocriptine wasreinitiated and the patient responded initially with decreasing headaches and declining PRL concentrations to1488 microg/L at 15 weeks gestation. However, PRL increased to 1836 microg/L at 16 weeks and remainedelevated despite bromocriptine 2.5 mg three times a day; in addition, she complained of severe nausea, vomiting, and persistent headaches. Cabergoline was added at 18 weeks gestation. PRL decreaseddramatically from 1710 to 859 microg/L in 1 week, and to 488 microg/L within 4 weeks. A repeat MRI showedmore than 30% reduction in tumor size. Bromocriptine was discontinued at 24 weeks gestation; she wasmaintained on cabergoline 0.5 mg twice a week without complaints. PRL levels ranged from 190 to 278 microg/L during the last 10 weeks of pregnancy. She had a C-section electively at 37 weeks gestation anddelivered a healthy baby. Management options in this patient and during pregnancy are discussed.

PMID: 12138991 [PubMed - indexed for MEDLINE]

Pituitary. 2001 Aug;4(3):179-85. Related Articles, Links

Successful treatment of a large macroprolactinoma with cabergolineduring pregnancy.

Liu C, Tyrrell JB.Department of Medicine, University of California, San Francisco, 94143-0326, USA. cliu@itsa.ucsf.edu

We report a pregnant woman with a large macroprolactinoma successfully treated with cabergoline after a suboptimal response to bromocriptine. A 7 week pregnant woman with a history of a prolactinoma presentedto the endocrine clinic with the complaints of headaches and nausea. She had a prolactin level of 65 microg/L 1 1/2 weeks following her last menstrual period. Bromocriptine was discontinued at 6 weeks gestation whenpregnancy was confirmed. A PRL concentration was 1899 microg/L (non-pregnant normal range 1.39-24.20 microg/L, the mean peak levels during pregnancy reported from the literature are 200-210 microg/L) at 7 weeks gestation, and a repeat was 2197 microg/L. An MRI showed a 3 x 2.2 x 2.5 cm seller mass abutting theoptic chiasm and displacing the optic nerves superiorly; the visual field testing was normal. Bromocriptine wasreinitiated and the patient responded initially with decreasing headaches and declining PRL concentrations to1488 microg/L at 15 weeks gestation. However, PRL increased to 1836 microg/L at 16 weeks and remainedelevated despite bromocriptine 2.5 mg three times a day; in addition, she complained of severe nausea, vomiting, and persistent headaches. Cabergoline was added at 18 weeks gestation. PRL decreaseddramatically from 1710 to 859 microg/L in 1 week, and to 488 microg/L within 4 weeks. A repeat MRI showedmore than 30% reduction in tumor size. Bromocriptine was discontinued at 24 weeks gestation; she wasmaintained on cabergoline 0.5 mg twice a week without complaints. PRL levels ranged from 190 to 278 microg/L during the last 10 weeks of pregnancy. She had a C-section electively at 37 weeks gestation anddelivered a healthy baby. Management options in this patient and during pregnancy are discussed.

PMID: 12138991 [PubMed - indexed for MEDLINE]

Se presenta el caso de unapaciente que presentóhiperprolactinemia en

el embarazoSe reinstaló el tratamiento que

había recibido previamente:bromocriptina

Pituitary. 2001 Aug;4(3):179-85. Related Articles, Links

Successful treatment of a large macroprolactinoma with cabergolineduring pregnancy.

Liu C, Tyrrell JB.Department of Medicine, University of California, San Francisco, 94143-0326, USA. cliu@itsa.ucsf.edu

We report a pregnant woman with a large macroprolactinoma successfully treated with cabergoline after a suboptimal response to bromocriptine. A 7 week pregnant woman with a history of a prolactinoma presentedto the endocrine clinic with the complaints of headaches and nausea. She had a prolactin level of 65 microg/L 1 1/2 weeks following her last menstrual period. Bromocriptine was discontinued at 6 weeks gestation whenpregnancy was confirmed. A PRL concentration was 1899 microg/L (non-pregnant normal range 1.39-24.20 microg/L, the mean peak levels during pregnancy reported from the literature are 200-210 microg/L) at 7 weeks gestation, and a repeat was 2197 microg/L. An MRI showed a 3 x 2.2 x 2.5 cm seller mass abutting theoptic chiasm and displacing the optic nerves superiorly; the visual field testing was normal. Bromocriptine wasreinitiated and the patient responded initially with decreasing headaches and declining PRL concentrations to1488 microg/L at 15 weeks gestation. However, PRL increased to 1836 microg/L at 16 weeks and remainedelevated despite bromocriptine 2.5 mg three times a day; in addition, she complained of severe nausea, vomiting, and persistent headaches. Cabergoline was added at 18 weeks gestation. PRL decreaseddramatically from 1710 to 859 microg/L in 1 week, and to 488 microg/L within 4 weeks. A repeat MRI showedmore than 30% reduction in tumor size. Bromocriptine was discontinued at 24 weeks gestation; she wasmaintained on cabergoline 0.5 mg twice a week without complaints. PRL levels ranged from 190 to 278 microg/L during the last 10 weeks of pregnancy. She had a C-section electively at 37 weeks gestation anddelivered a healthy baby. Management options in this patient and during pregnancy are discussed.

PMID: 12138991 [PubMed - indexed for MEDLINE]

Se presenta el caso de unapaciente que presentóhiperprolactinemia en

el embarazoSe reinstaló el tratamiento que

había recibido previamente:bromocriptina

A las 15 semanas la paciente dejóde responder a la

bromocriptina y presentósíntomas de expansión tumoral

Pituitary. 2001 Aug;4(3):179-85. Related Articles, Links

Successful treatment of a large macroprolactinoma with cabergolineduring pregnancy.

Liu C, Tyrrell JB.Department of Medicine, University of California, San Francisco, 94143-0326, USA. cliu@itsa.ucsf.edu

We report a pregnant woman with a large macroprolactinoma successfully treated with cabergoline after a suboptimal response to bromocriptine. A 7 week pregnant woman with a history of a prolactinoma presentedto the endocrine clinic with the complaints of headaches and nausea. She had a prolactin level of 65 microg/L 1 1/2 weeks following her last menstrual period. Bromocriptine was discontinued at 6 weeks gestation whenpregnancy was confirmed. A PRL concentration was 1899 microg/L (non-pregnant normal range 1.39-24.20 microg/L, the mean peak levels during pregnancy reported from the literature are 200-210 microg/L) at 7 weeks gestation, and a repeat was 2197 microg/L. An MRI showed a 3 x 2.2 x 2.5 cm seller mass abutting theoptic chiasm and displacing the optic nerves superiorly; the visual field testing was normal. Bromocriptine wasreinitiated and the patient responded initially with decreasing headaches and declining PRL concentrations to1488 microg/L at 15 weeks gestation. However, PRL increased to 1836 microg/L at 16 weeks and remainedelevated despite bromocriptine 2.5 mg three times a day; in addition, she complained of severe nausea, vomiting, and persistent headaches. Cabergoline was added at 18 weeks gestation. PRL decreaseddramatically from 1710 to 859 microg/L in 1 week, and to 488 microg/L within 4 weeks. A repeat MRI showedmore than 30% reduction in tumor size. Bromocriptine was discontinued at 24 weeks gestation; she wasmaintained on cabergoline 0.5 mg twice a week without complaints. PRL levels ranged from 190 to 278 microg/L during the last 10 weeks of pregnancy. She had a C-section electively at 37 weeks gestation anddelivered a healthy baby. Management options in this patient and during pregnancy are discussed.

PMID: 12138991 [PubMed - indexed for MEDLINE]

Se presenta el caso de unapaciente que presentóhiperprolactinemia en

el embarazoSe reinstaló el tratamiento que

había recibido previamente:bromocriptina

A las 15 semanas la paciente dejóde responder a la

bromocriptina y presentósíntomas de expansión tumoral

Se cambió la droga porcabergolina con

buen resultado terapéutico

: Int J Gynaecol Obstet. 1986 Jun;24(3):209-15. Related Articles, Links

Rapid regression through bromocriptine therapy of a suprasellar extendingprolactinoma during pregnancy.

Tan SL, Jacobs HS.A 29-year-old woman is described who presented with amenorrhea and galactorrhea with a large prolactinomawhich regressed on bromocriptine therapy. Treatment with bromocriptine was stopped when pregnancy wasdiagnosed but 6 weeks later the prolactinoma had regrown with suprasellar extension and lateral invasion of thecavernous sinus. When treatment with bromocriptine was reinstituted symptoms subsided within 24 h and serumprolactin concentrations fell from 54,000 mM/l to 2800 mU/l within 5 days and 500 mU/l 2 days after that. Pregnancy proceeded without complications and she entered spontaneous labor at term and delivered a healthybaby. One year after delivery, on treatment with bromocriptine, her serum prolactin concentration remainswithin the normal range and the CT scan shows persistence of a small prolactinoma, confined to the pituitaryfossa. Bromocriptine should be the primary treatment for prolactinomas regardless of tumor size and may be safely stopped when pregnancy is desired. If pituitary tumor complications occur during pregnancy, reintroductionof treatment with bromocriptine should again be the treatment of choice.

PMID: 2880760 [PubMed - indexed for MEDLINE]

: Int J Gynaecol Obstet. 1986 Jun;24(3):209-15. Related Articles, Links

Rapid regression through bromocriptine therapy of a suprasellar extendingprolactinoma during pregnancy.

Tan SL, Jacobs HS.A 29-year-old woman is described who presented with amenorrhea and galactorrhea with a large prolactinomawhich regressed on bromocriptine therapy. Treatment with bromocriptine was stopped when pregnancy wasdiagnosed but 6 weeks later the prolactinoma had regrown with suprasellar extension and lateral invasion of thecavernous sinus. When treatment with bromocriptine was reinstituted symptoms subsided within 24 h and serumprolactin concentrations fell from 54,000 mM/l to 2800 mU/l within 5 days and 500 mU/l 2 days after that. Pregnancy proceeded without complications and she entered spontaneous labor at term and delivered a healthybaby. One year after delivery, on treatment with bromocriptine, her serum prolactin concentration remainswithin the normal range and the CT scan shows persistence of a small prolactinoma, confined to the pituitaryfossa. Bromocriptine should be the primary treatment for prolactinomas regardless of tumor size and may be safely stopped when pregnancy is desired. If pituitary tumor complications occur during pregnancy, reintroductionof treatment with bromocriptine should again be the treatment of choice.

PMID: 2880760 [PubMed - indexed for MEDLINE]

Se suspendió el tratamientocon bromocriptina a una

paciente de 29 a.cuando embarazó

A las 6 semanas el tumor creció rápidamente

extendiéndose a regionessupraselares

: Int J Gynaecol Obstet. 1986 Jun;24(3):209-15. Related Articles, Links

Rapid regression through bromocriptine therapy of a suprasellar extendingprolactinoma during pregnancy.

Tan SL, Jacobs HS.A 29-year-old woman is described who presented with amenorrhea and galactorrhea with a large prolactinomawhich regressed on bromocriptine therapy. Treatment with bromocriptine was stopped when pregnancy wasdiagnosed but 6 weeks later the prolactinoma had regrown with suprasellar extension and lateral invasion of thecavernous sinus. When treatment with bromocriptine was reinstituted symptoms subsided within 24 h and serumprolactin concentrations fell from 54,000 mM/l to 2800 mU/l within 5 days and 500 mU/l 2 days after that. Pregnancy proceeded without complications and she entered spontaneous labor at term and delivered a healthybaby. One year after delivery, on treatment with bromocriptine, her serum prolactin concentration remainswithin the normal range and the CT scan shows persistence of a small prolactinoma, confined to the pituitaryfossa. Bromocriptine should be the primary treatment for prolactinomas regardless of tumor size and may be safely stopped when pregnancy is desired. If pituitary tumor complications occur during pregnancy, reintroductionof treatment with bromocriptine should again be the treatment of choice.

PMID: 2880760 [PubMed - indexed for MEDLINE]

Se suspendió el tratamientocon bromocriptina a una

paciente de 29 a.cuando embarazó

A las 6 semanas el tumor creció rápidamente

extendiéndose a regionessupraselares

El nivel de prolactina superólas 54.000 mui/l

: Int J Gynaecol Obstet. 1986 Jun;24(3):209-15. Related Articles, Links

Rapid regression through bromocriptine therapy of a suprasellar extendingprolactinoma during pregnancy.

Tan SL, Jacobs HS.A 29-year-old woman is described who presented with amenorrhea and galactorrhea with a large prolactinomawhich regressed on bromocriptine therapy. Treatment with bromocriptine was stopped when pregnancy wasdiagnosed but 6 weeks later the prolactinoma had regrown with suprasellar extension and lateral invasion of thecavernous sinus. When treatment with bromocriptine was reinstituted symptoms subsided within 24 h and serumprolactin concentrations fell from 54,000 mM/l to 2800 mU/l within 5 days and 500 mU/l 2 days after that. Pregnancy proceeded without complications and she entered spontaneous labor at term and delivered a healthybaby. One year after delivery, on treatment with bromocriptine, her serum prolactin concentration remainswithin the normal range and the CT scan shows persistence of a small prolactinoma, confined to the pituitaryfossa. Bromocriptine should be the primary treatment for prolactinomas regardless of tumor size and may be safely stopped when pregnancy is desired. If pituitary tumor complications occur during pregnancy, reintroductionof treatment with bromocriptine should again be the treatment of choice.

PMID: 2880760 [PubMed - indexed for MEDLINE]

Se suspendió el tratamientocon bromocriptina a una

paciente de 29 a.cuando embarazó

A las 6 semanas el tumor creció rápidamente

extendiéndose a regionessupraselares

El nivel de prolactina superólas 54.000 mui/l

El tumor regresó rápidamente ylos niveles de prolactina descendieron

a 500 mUI/l a los 7 díasde reinstalado el tratamiento con

bromocriptina

Fertil Steril. 1992 Sep;58(3):492-7. Related Articles, Links

Macroprolactinomas with suprasellar extension: effect of bromocriptinewithdrawal during one or more pregnancies.

Ahmed M, al-Dossary E, Woodhouse NJ.Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.

OBJECTIVE: To investigate the effects of bromocriptine withdrawal during one or more pregnancies in patientswho presented with pituitary macroprolactinomas with suprasellar extension. DESIGN: Four infertile patientspresenting with a macroprolactinoma with suprasellar extension conceived during treatment with bromocriptine on10 occasions resulting in eight full-term normal deliveries. Treatment was withheld shortly after conception in each pregnancy. RESULTS: Serum prolactin (PRL) levels fell initially from a mean of 2,776 (range 1,682 to4,515) to 27 micrograms/L (range 1 to 71) with the development of a partially empty sella in all patients. Recovery of visual field defects occurred in the only affected individual. In case 1, PRL levels remained withinthe normal range, after bromocriptine withdrawal in the first pregnancy, with the development of an emptysella. Prolactin levels, however, increased substantially in cases 2 to 4. An asymptomatic suprasellar tumor extension returned in cases 2 and 3. After two or more pregnancies (cases 1, 3, and 4), there was a progressive decline in the serum PRL levels. Although still elevated in cases 3 and 4, the PRL levels wereconsiderably below those obtained at presentation or in the first pregnancy. Tumor regression with thedevelopment of an empty sella was observed in both these patients as well in their pregnancy or postpartumperiod. CONCLUSIONS: Bromocriptine may be safely withdrawn during pregnancy in patients presenting with a macroprolactinoma. With multiple bromocriptine induced pregnancies, PRL levels and tumor size may progressivelydecrease with the eventual development of an empty sella.

PMID: 1521641 [PubMed - indexed for MEDLINE]

Fertil Steril. 1992 Sep;58(3):492-7. Related Articles, Links

Macroprolactinomas with suprasellar extension: effect of bromocriptinewithdrawal during one or more pregnancies.

Ahmed M, al-Dossary E, Woodhouse NJ.Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.

OBJECTIVE: To investigate the effects of bromocriptine withdrawal during one or more pregnancies in patientswho presented with pituitary macroprolactinomas with suprasellar extension. DESIGN: Four infertile patientspresenting with a macroprolactinoma with suprasellar extension conceived during treatment with bromocriptine on10 occasions resulting in eight full-term normal deliveries. Treatment was withheld shortly after conception in each pregnancy. RESULTS: Serum prolactin (PRL) levels fell initially from a mean of 2,776 (range 1,682 to4,515) to 27 micrograms/L (range 1 to 71) with the development of a partially empty sella in all patients. Recovery of visual field defects occurred in the only affected individual. In case 1, PRL levels remained withinthe normal range, after bromocriptine withdrawal in the first pregnancy, with the development of an emptysella. Prolactin levels, however, increased substantially in cases 2 to 4. An asymptomatic suprasellar tumor extension returned in cases 2 and 3. After two or more pregnancies (cases 1, 3, and 4), there was a progressive decline in the serum PRL levels. Although still elevated in cases 3 and 4, the PRL levels wereconsiderably below those obtained at presentation or in the first pregnancy. Tumor regression with thedevelopment of an empty sella was observed in both these patients as well in their pregnancy or postpartumperiod. CONCLUSIONS: Bromocriptine may be safely withdrawn during pregnancy in patients presenting with a macroprolactinoma. With multiple bromocriptine induced pregnancies, PRL levels and tumor size may progressivelydecrease with the eventual development of an empty sella.

PMID: 1521641 [PubMed - indexed for MEDLINE]

Se puede interrumpir el tratamiento de los tumoreshipofisarios con extensión

supraselar cuando selogra el embarazo

A lo largo de sucesivosembarazos logrados con

Bromocriptina, los niveles dePRL tienden a disminuir

así comoel tamaño tumoral

Fertil Steril. 1992 Sep;58(3):492-7. Related Articles, Links

Macroprolactinomas with suprasellar extension: effect of bromocriptinewithdrawal during one or more pregnancies.

Ahmed M, al-Dossary E, Woodhouse NJ.Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.

OBJECTIVE: To investigate the effects of bromocriptine withdrawal during one or more pregnancies in patientswho presented with pituitary macroprolactinomas with suprasellar extension. DESIGN: Four infertile patientspresenting with a macroprolactinoma with suprasellar extension conceived during treatment with bromocriptine on10 occasions resulting in eight full-term normal deliveries. Treatment was withheld shortly after conception in each pregnancy. RESULTS: Serum prolactin (PRL) levels fell initially from a mean of 2,776 (range 1,682 to4,515) to 27 micrograms/L (range 1 to 71) with the development of a partially empty sella in all patients. Recovery of visual field defects occurred in the only affected individual. In case 1, PRL levels remained withinthe normal range, after bromocriptine withdrawal in the first pregnancy, with the development of an emptysella. Prolactin levels, however, increased substantially in cases 2 to 4. An asymptomatic suprasellar tumor extension returned in cases 2 and 3. After two or more pregnancies (cases 1, 3, and 4), there was a progressive decline in the serum PRL levels. Although still elevated in cases 3 and 4, the PRL levels wereconsiderably below those obtained at presentation or in the first pregnancy. Tumor regression with thedevelopment of an empty sella was observed in both these patients as well in their pregnancy or postpartumperiod. CONCLUSIONS: Bromocriptine may be safely withdrawn during pregnancy in patients presenting with a macroprolactinoma. With multiple bromocriptine induced pregnancies, PRL levels and tumor size may progressivelydecrease with the eventual development of an empty sella.

PMID: 1521641 [PubMed - indexed for MEDLINE]

Se puede interrumpir el tratamiento de los tumoreshipofisarios con extensión

supraselar cuando selogra el embarazo

A lo largo de sucesivosembarazos logrados con

Bromocriptina, los niveles dePRL tienden a disminuir

así comoel tamaño tumoral

La reducción el algunoscasos alcanza el grado de

silla turca vacía