Part of “CHAPTER 13 – PROLACTIN AND ITS DISORDERS“

Many women with hyperprolactinemia present with infertility; bromocriptine is typically used to normalize prolactin levels and allow normal ovulation to occur. After pregnancy is established, bromocriptine should be discontinued if no evidence of local tumor compression is seen. Pregnancy in normal women leads to increased pituitary size through estrogen-stimulated lactotrope hyperplasia. For patients with prolactinomas, the concern is that the high estrogen levels associated with pregnancy may lead to lactotrope stimulation and tumor growth, with resulting local complications, including visual field deficits, headaches, and diabetes insipidus. In a review of the data on pregnancy outcomes in hyperprolactinemic patients, clinically significant tumor enlargement (e.g., causing headaches, visual deficits) were found in as many as 5.5% of patients with microprolactinomas.81 Patients with microprolactinomas should be followed carefully during pregnancy, with visual field monitoring at monthly intervals.