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Managing prolactin-secreting adenomas during pregnancy

Ehud Ur, MB BS FRCP
Professor in the Division of Endocrinology and Metabolism

David B. Clarke, MD CM PhD FRCSC FACS
Associate Professor in the Division of Neurosurgery at Dalhousie University in Halifax, NS

Correspondence to: Dr S.A. Imran, Division of Endocrinology and Metabolism, 7th Floor, VG site, 1278 Tower Rd, Halifax, NS B3H 2Y9; telephone 902 473–3727; fax 902 473–3726; e-mail ali.imran{at}cdha.nshealth.ca

OBJECTIVE To determine an appropriate approach to managing prolactin-secreting adenomas of varying severity in pregnant women.

SOURCES OF INFORMATION MEDLINE was searched using the key words "hyperprolactinemia," "prolactinoma," "pregnancy," and "management." Experience from a multidisciplinary tertiary care centre was also reviewed. Recommendations are based on mostly levels II and III evidence.

MAIN MESSAGE With appropriate management, most women with hyperprolactinemia can achieve pregnancy. Although most women with prolactin-secreting adenomas during pregnancy need only careful observation, others might require medical treatment or even surgical evacuation. Ideally, such patients should be managed by multidisciplinary teams. In the absence of such teams, most pregnant women with small tumours can be managed safely by their primary physicians. Those with large tumours should be referred to specialists.

CONCLUSION Family physicians play an important role in managing women with prolactinomas during pregnancy. Knowledge of current approaches to management is crucial in determining when and how to refer these patients.