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Official reprint from UpToDate®

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© 2022 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Management of lactotroph adenoma (prolactinoma)

before and during pregnancy
Author: Peter J Snyder, MD
Section Editors: David S Cooper, MD, Charles J Lockwood, MD, MHCM
Deputy Editor: Kathryn A Martin, MD

All topics are updated as new evidence becomes available and our peer review process is complete.

Literature review current through: May 2022. | This topic last updated: May 09, 2022.

INTRODUCTION

Most women with lactotroph adenomas have anovulatory infertility and even frank
hypogonadism but are able to conceive once the lactotroph adenoma has been treated and the
serum prolactin concentration has been lowered to normal. Patient counseling before
pregnancy should include a discussion about the risks of adenoma growth during pregnancy
and the potential effects of exposure to dopamine agonists on the fetus (which is very low).

The management of women with lactotroph adenomas before and during pregnancy will be
reviewed here. Other aspects of hyperprolactinemia and lactotroph adenomas are reviewed
separately.

● (See "Causes of hyperprolactinemia".)

● (See "Clinical manifestations and evaluation of hyperprolactinemia".)
● (See "Management of hyperprolactinemia".)

PATIENT COUNSELING BEFORE PREGNANCY

Management of a patient with lactotroph adenoma who wants to conceive should begin with a
discussion about options for lowering serum prolactin to normal (to restore ovulation) and
counseling about the potential risks of treatment during pregnancy to her and the fetus (
algorithm 1).

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Maternal risk of adenoma growth — The principal risk during pregnancy to a mother with a
lactotroph adenoma is an increase in adenoma size sufficient to cause neurologic symptoms,
most importantly visual impairment. The risk that an increase in lactotroph adenoma size will
be clinically important depends upon the size of the adenoma before pregnancy. Thus, all
patients with a lactrotroph adenoma should be treated prior to pursuing pregnancy to lower
serum prolactin concentrations and decrease adenoma size (macroadenomas) ( algorithm 1).

● Pituitary growth during normal pregnancy – The theoretical basis for adenoma growth
during pregnancy is lactotroph hyperplasia in response to rising levels of serum estradiol
[1]. In a study of 32 pregnant women and 20 nonpregnant women, pituitary volume (as
assessed by magnetic resonance imaging [MRI]) was more than double the size in the
pregnant women by the third trimester compared with the nonpregnant women (
figure 1) [2]. Similarly, in women with lactotroph adenomas who become pregnant, the
higher levels of estradiol of pregnancy may increase the size of the lactotroph adenoma.

● Microadenoma – For a microadenoma (<10 mm in diameter), the risk of growth is very

low [3-6]. A review of 14 studies reporting a total of 764 patients with lactotroph
microadenomas showed that only 2.4 percent exhibited a symptomatic increase in the size
of the adenoma during pregnancy [1].

● Macroadenoma – The risk of growth of a lactotroph macroadenoma (≥10 mm) during

pregnancy is substantially higher. In the same review as above [1], while only 4.8 percent
of 148 women who had macroadenomas that had been treated by prior surgery or
radiation developed clinically significant enlargement during pregnancy, 22.9 percent of
214 women without such treatment did. Enlargement not accompanied by symptoms or
visual field deficit was not counted.

Fetal risk of dopamine agonist exposure — Although dopamine agonists are typically

discontinued when pregnancy is confirmed, pregnancy has usually progressed at least two
weeks before confirmation occurs, so the fetus is exposed to the dopamine agonist during that
time. Available evidence does not suggest risk to the fetus from this exposure ( algorithm 1).

Data from over 6000 pregnancies suggest that the administration of bromocriptine during the
first month of pregnancy does not harm the fetus [6]. In this series, the incidence of
spontaneous abortions (9.9 percent), multiple births (1.7 percent), and malformations (1.8
percent) was no higher than in the general population. In addition, in a study of children
followed for up to nine years after exposure to bromocriptine in utero, no harmful effects were
noted [7].

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Rarely, dopamine agonist treatment is resumed during pregnancy if adenoma size increases so
much as to impair vision. Continuous use of bromocriptine during pregnancy has been
reported in approximately 100 women. Although the rate of congenital malformations did not
appear to be higher than nonexposed pregnancies, there was one case of undescended testis
and one of talipes deformity [6,8]. (See 'Treatment of enlarging adenoma' below.)

Although the number of pregnancies in women taking cabergoline at the time of conception is
much smaller (968), the evidence suggests that this drug is safe as well. In one review of over
700 cases, the incidence of spontaneous abortions (7.5 percent), multiple births (2.4 percent),
and malformations (2.4 percent) was no higher than in the general population [1]. Patients with
Parkinson disease treated with high doses of cabergoline (eg, >20 mg per week) have an
increased risk of valvular heart disease, but this risk has not been demonstrated using the
lower doses used for lactotroph adenomas [9]. (See "Valvular heart disease induced by drugs".)

TREATMENT BEFORE PREGNANCY

Patients with microadenomas

Restoration of ovulation — Hyperprolactinemia suppresses pituitary gonadotropin secretion,

resulting in irregular menstrual cycles and anovulatory infertility. Serum prolactin
concentrations between 50 to 100 ng/mL (normal <15 to 20 ng/mL), typically cause either
amenorrhea or oligomenorrhea, while levels greater than 100 ng/mL result in deficient
estradiol and progesterone secretion and amenorrhea ( algorithm 1). (See "Clinical
manifestations and evaluation of hyperprolactinemia", section on 'Menstrual cycle
dysfunction'.)

For women with lactotroph microadenomas, treatment with a dopamine agonist usually
normalizes prolactin and thereby removes the inhibition of gonadotropin secretion and restores
normal ovulation and fertility. As noted, available evidence adoes not suggest risk to the fetus
from dopamine agonist use for ovulation induction. (See 'Fetal risk of dopamine agonist
exposure' above.)

Dopamine agonist therapy — A dopamine agonist is the treatment of choice for women
with a lactotroph adenoma. A marked reduction in the serum prolactin concentration often
occurs within two to three weeks ( figure 2). Restoration of ovulation occurs in over 90
percent of women with hyperprolactinemia and anovulation ( algorithm 1) [10]. (See
"Management of hyperprolactinemia", section on 'Overview of dopamine agonists'.)

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The occurrence of regular menstrual cycles during treatment indicates that the woman is
probably ovulating. Following correction of hyperprolactinemia, successful pregnancy can be
achieved in over 85 percent of patients [11]. Neither cabergoline nor bromocriptine has been
associated with an increased risk of miscarriage, congenital malformations, or pregnancy
complications such as preterm deliveries.

We suggest stopping the dopamine agonist in women with either a micro- or macroadenoma
once pregnancy has been confirmed. Because of the limited number of patients who have been
treated throughout pregnancy, the safety of continued usage has not been established.

The choice of dopamine agonist and dosing are described below. (See 'Choice of dopamine
agonist' below and 'Dosing' below.)

Add clomiphene if needed — For women who do not ovulate or do not conceive with
dopamine agonist therapy, clomiphene citrate may be added [12]. If unsuccessful,
gonadotropin therapy may be needed, although this therapy is associated with high serum
estradiol concentrations during treatment and a significant risk of multiple gestations (
algorithm 1). If pregnancy is not achieved using a dopamine agonist and clomiphene, we
recommend referral to a specialist in reproductive endocrinology and reproduction. (See
"Overview of ovulation induction".)

Patients with macroadenomas — For a woman with macroadenoma, adenoma size should be

reduced and ovulation restored before pregnancy is attempted. A dopamine agonist may do
both, but surgery may also be required. (See 'Transsphenoidal surgery to decrease adenoma
size' below.)

Dopamine agonist to decrease size — A woman who has a lactotroph macroadenoma

should be advised of the relatively higher risk of clinically important adenoma enlargement
during pregnancy, as described above [6]. (See 'Maternal risk of adenoma growth' above.)

We recommend a dopamine agonist as the initial treatment of a lactotroph adenoma, whether

or not the adenoma is elevating the optic chiasm. Once the adenoma size has decreased
dramatically and is well within the confines of the sella and ovulation has been restored,
pregnancy can be attempted. Reduction in size in this way should reduce the chance of clinically
important enlargement during pregnancy [3,13].

Transsphenoidal surgery to decrease adenoma size — If the adenoma elevates the optic
chiasm and does not shrink substantially in response to a dopamine agonist, we recommend
transsphenoidal surgery to reduce adenoma size. Prior surgery reduces the chance that
symptomatic expansion will occur during pregnancy [1], but it may still occur. (See
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"Transsphenoidal surgery for pituitary adenomas and other sellar masses", section on
'Lactotroph adenomas'.)

We also suggest surgery in a woman whose macroadenoma (≥10 mm) is unresponsive to

bromocriptine or cabergoline, even if it is not elevating the optic chiasm, because a dopamine
agonist is unlikely to be effective if the adenoma enlarges during pregnancy.

Choice of dopamine agonist — Most experts now prefer cabergoline over bromocriptine

because it is more effective and easier to tolerate. When a dopamine agonist is needed to lower
the serum prolactin concentration to permit ovulation, cabergoline has the advantage that it is
more likely to be tolerated and more likely to be effective in lowering the prolactin, although
bromocriptine has the advantage of the somewhat greater certainty that it does not cause
congenital anomalies. (See 'Fetal risk of dopamine agonist exposure' above.)

Dosing

● Cabergoline – The starting dose of cabergoline, 0.25 mg twice a week, should be the
same for both micro- and macroadenomas. Bedtime administration reduces the already
small chance of nausea and orthostatic hypotension. If the serum prolactin concentration
does not normalize after one to two months, the dose can be increased to 0.5 mg twice a
week and then, if necessary, titrated up to 1 mg twice a week.

Patients with macroadenomas often require higher doses to reduce the size of the
adenoma and the prolactin concentration [11]. However, some macroadenomas, even
with serum prolactin concentrations in the tens of thousands, will respond to the lower
doses described.

● Bromocriptine – For bromocriptine, start with 1.25 mg at bedtime for one week, then 1.25
mg twice a day for one to two months. If the serum prolactin concentration does not fall
to near-normal or normal by then, the dose can be increased to 2.5 mg twice a day and, if
necessary, to 5 mg twice a day. If nausea occurs or if serum prolactin does not decrease to
normal, consider changing to cabergoline.

DURING PREGNANCY

Women with lactotroph adenomas, in particular those with macroadenomas, should be

monitored closely during pregnancy. The approach outlined here is consistent with the 2011
Endocrine Society Clinical Practice Guidelines on the diagnosis and treatment of
hyperprolactinemia [14].

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Monitoring

● Symptoms – Patients should be seen at routine intervals and asked about headaches and
changes in vision (as indicators of potential adenoma growth).

Women with microadenomas should be seen every three months and asked about
headaches and change in vision, symptoms that could indicate adenoma enlargement. A
change in vision should prompt assessing visual fields.

Women with macroadenomas should also be seen at least every three months (more
often the larger the adenoma) and asked about headaches and changes in vision.

● Serum prolactin – During normal pregnancy, serum prolactin concentrations increase to

as high as 400 ng/mL. Women with lactotroph adenomas may experience an increase in
serum prolactin to pretreatment levels ( figure 3). However, not all women with
lactotroph adenomas experience a similar increase [6].

The Endocrine Society guidelines recommend against measuring prolactin during

pregnancy because it can be difficult to distinguish the normal pregnancy-associated rise
in prolactin from that associated with adenoma growth [14]. However, the author of this
topic does measure serum prolactin in women with both macro- and microadenomas
every three months during pregnancy because it is reassuring if the prolactin does not
increase above 400 ng/mL (the upper limit of normal in the third trimester for pregnant
women without lactotroph adenomas). If the prolactin does increase to >400 ng/mL, visual
field testing should be performed.

Visual field testing — For most pregnant women with lactotroph adenomas, routine visual
field testing is not indicated. However, women who develop visual symptoms during pregnancy
should have visual field testing. In addition, women whose macroadenomas extend above the
sella should undergo visual field testing before pregnancy and every three months during the
pregnancy, even if the patient has no visual symptoms. If a visual field defect consistent with a
sellar mass is found (diminished vision in the temporal fields [bitemporal hemianopsia]), MRI
without contrast should be performed.

Pituitary MRI — Routine pituitary MRI is not indicated in women with lactotroph adenomas
during pregnancy, because the risk of adenoma growth is very low. However, if a patient
develops severe headaches or visual field abnormalities, pituitary MRI without contrast should
be performed to assess adenoma size. (See 'Maternal risk of adenoma growth' above.)

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Treatment of enlarging adenoma — If the adenoma has enlarged to a degree that could
account for the headaches and/or visual field defect, the patient should be treated with a
dopamine agonist throughout the remainder of the pregnancy, and she should be seen at least
once a month to reevaluate symptoms and visual fields. This treatment will usually decrease the
size of the adenoma and alleviate the symptoms [8,15]. We suggest using the same dopamine
agonist the patient took and tolerated previously. (See 'Choice of dopamine agonist' above and
'Dosing' above.)

If cabergoline is not successful in alleviating severely compromised vision after several weeks,
we suggest transsphenoidal surgery in the second trimester. In contrast, in the third trimester,
surgery for persistent visual symptoms should be deferred until after delivery, if possible.

Pituitary apoplexy — Pituitary apoplexy refers to sudden hemorrhage into the pituitary, a rare
event with potential serious neurologic and endocrine consequences. Apoplexy can occur in
patients with pituitary micro- or macroadenomas, including women with lactotroph
macroadenomas during any trimester of pregnancy [16]. In its most dramatic presentation,
apoplexy causes the sudden onset of excruciating headache, diplopia due to pressure on the
oculomotor nerves, and hypopituitarism. All pituitary hormonal deficiencies can occur, but the
sudden onset of corticotropin (ACTH) and therefore cortisol deficiency is the most serious
because it can cause life-threatening hypotension. It should be treated with high-dose
hydrocortisone. (See "Causes of hypopituitarism", section on 'Pituitary apoplexy'.)

Most patients who develop apoplexy were not known to have an adenoma previously, and
when tissue is excised surgically, it is necrotic, so the cell type cannot be identified.

AFTER PREGNANCY

Breastfeeding and dopamine agonists — Breastfeeding increases serum prolactin

concentrations ( figure 4) but does not appear to increase the risk of lactotroph adenoma
growth [17,18]. Therefore, breastfeeding is an option for women with micro- and
macroadenomas that remained stable in size during pregnancy. Dopamine agonist therapy,
which lowers serum prolactin and inhibits lactation, should be withheld until breastfeeding is
completed.

In contrast, breastfeeding is contraindicated in women who have visual field impairment

because they should be treated with a dopamine agonist.

Normalization of prolactin after pregnancy — To evaluate the need for further dopamine
agonist therapy after pregnancy, serum prolactin should be measured approximately three
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months after delivery in women who do not breastfeed and after cessation of breastfeeding in
those who do. Serum prolactin normalizes within 6 to 12 weeks postpartum in women who do
not breastfeed. (See "Causes of hyperprolactinemia", section on 'Nipple stimulation and breast
examinations'.)

● In a study of 143 pregnancies in 91 patients with hyperprolactinemia treated with

cabergoline prior to pregnancy, no further treatment was necessary to maintain a normal
serum prolactin concentration in 68 percent of the patients for up to 60 months
postpartum [19]. Breastfeeding did not affect the results. Recurrence was slightly greater
in those who had macroadenomas than in those who had microadenomas.

● In a study of 104 pregnancies in 73 patients with lactotroph adenomas treated with a

dopamine agonist prior to pregnancy, 41 percent had a normal serum prolactin
concentration a median of 22 months after delivery or cessation of lactation [20]. Those
who had normal prolactin levels had pituitary glands of normal size.

SOCIETY GUIDELINE LINKS

Links to society and government-sponsored guidelines from selected countries and regions
around the world are provided separately. (See "Society guideline links:
Hyperprolactinemia/prolactinoma".)

INFORMATION FOR PATIENTS

UpToDate offers two types of patient education materials, "The Basics" and "Beyond the
Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade
reading level, and they answer the four or five key questions a patient might have about a given
condition. These articles are best for patients who want a general overview and who prefer
short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more
sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading
level and are best for patients who want in-depth information and are comfortable with some
medical jargon.

Here are the patient education articles that are relevant to this topic. We encourage you to print
or e-mail these topics to your patients. (You can also locate patient education articles on a
variety of subjects by searching on "patient info" and the keyword(s) of interest.)

● Basics topics (see "Patient education: Prolactinoma (The Basics)")

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● Beyond the Basics topics (see "Patient education: High prolactin levels and prolactinomas
(Beyond the Basics)")

SUMMARY AND RECOMMENDATIONS

● Preconception counseling – Management of a patient with lactotroph adenoma who

wants to conceive should begin with a discussion about options for lowering serum
prolactin to normal (to restore ovulation) and counseling about the potential risks of
treatment during pregnancy to her and the fetus. The main concern for the mother is
adenoma growth, while the main concern for the fetus has been exposure to a dopamine
agonist. Fortunately, available evidence suggests that both bromocriptine and cabergoline
are safe. (See 'Patient counseling before pregnancy' above.)

● Dopamine agonists for ovulation induction – When pharmacologic therapy is needed to

lower the serum prolactin concentration to permit ovulation, we suggest a dopamine
agonist (Grade 2C). (See 'Restoration of ovulation' above.)

We suggest cabergoline rather than bromocriptine as initial therapy (Grade 2C).

Cabergoline is more likely to be tolerated and to be effective in lowering the prolactin.
However, bromocriptine has the advantage of the greater certainty that it does not cause
congenital anomalies. (See 'Dopamine agonist therapy' above.)

● Decrease adenoma size prior to pregnancy

• Dopamine agonists – For women with macroadenomas, we suggest initial therapy

with a dopamine agonist rather than transsphenoidal surgery to decrease the size of
the adenoma prior to pregnancy, whether the adenoma elevates the optic chiasm or
not (Grade 2C). (See 'Dopamine agonist to decrease size' above.)

• Transsphenoidal surgery – We reserve transsphenoidal surgery for patients with:

An inadequate response to dopamine agonists (macroadenomas that do not decrease

to a size that is within the sella). Surgery reduces the chance that symptomatic
expansion will occur during pregnancy (although it may still occur).

Macroadenomas within the sella that do not respond at all to dopamine agonists.
Preconception transsphenoidal surgery is indicated because dopamine agonist therapy
is not an option in the event of adenoma growth during pregnancy. (See
'Transsphenoidal surgery to decrease adenoma size' above.)

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● During pregnancy

• Stop dopamine agonist – Once pregnancy has been confirmed, we stop dopamine
agonist therapy because the safety of continued usage throughout pregnancy has not
been established. (See 'Dopamine agonist therapy' above.)

• Monitoring – Women with either a micro- or macroadenoma should be seen every

three months to evaluate for possible adenoma growth. (See 'Monitoring' above.)

• Macroadenoma growth – For women with evidence of macroadenoma growth on

pituitary MRI (performed for severe headaches or visual field abnormalities), we
suggest treatment with cabergoline or bromocriptine throughout the remainder of the
pregnancy (Grade 2C). Transsphenoidal surgery is sometimes needed if dopamine
agonists are not successful and vision is severely compromised. (See 'Treatment of
enlarging adenoma' above.)

● Postpartum use of dopamine agonists – Breastfeeding is not contraindicated in women

who have lactotroph adenomas, but dopamine agonists should not be used during
breastfeeding, because they impair lactation. An exception is a woman who has visual field
impairment, who should not breastfeed and should be treated with a dopamine agonist.
(See 'Breastfeeding and dopamine agonists' above.)

● Normalization of prolactin – Forty to 60 percent of women who were treated with

dopamine agonists for lactotroph adenomas prior to pregnancy do not require them
afterwards. Therefore, women should be reevaluated by measurement of the serum
prolactin concentration three months after delivery in women who do not breastfeed or
after cessation of breastfeeding. (See 'Normalization of prolactin after pregnancy' above.)

Use of UpToDate is subject to the Terms of Use.

REFERENCES

1. Molitch ME. Endocrinology in pregnancy: management of the pregnant patient with a

prolactinoma. Eur J Endocrinol 2015; 172:R205.

2. Gonzalez JG, Elizondo G, Saldivar D, et al. Pituitary gland growth during normal pregnancy:
an in vivo study using magnetic resonance imaging. Am J Med 1988; 85:217.

3. Gemzell C, Wang CF. Outcome of pregnancy in women with pituitary adenoma. Fertil Steril
1979; 31:363.

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4. Kupersmith MJ, Rosenberg C, Kleinberg D. Visual loss in pregnant women with pituitary
adenomas. Ann Intern Med 1994; 121:473.
5. Casanueva FF, Molitch ME, Schlechte JA, et al. Guidelines of the Pituitary Society for the
diagnosis and management of prolactinomas. Clin Endocrinol (Oxf) 2006; 65:265.
6. Molitch ME. Prolactinoma in pregnancy. Best Pract Res Clin Endocrinol Metab 2011; 25:885.

7. Raymond JP, Goldstein E, Konopka P, et al. Follow-up of children born of bromocriptine-

treated mothers. Horm Res 1985; 22:239.

8. Konopka P, Raymond JP, Merceron RE, Seneze J. Continuous administration of

bromocriptine in the prevention of neurological complications in pregnant women with
prolactinomas. Am J Obstet Gynecol 1983; 146:935.
9. Schade R, Andersohn F, Suissa S, et al. Dopamine agonists and the risk of cardiac-valve
regurgitation. N Engl J Med 2007; 356:29.
10. Gillam MP, Molitch ME, Lombardi G, Colao A. Advances in the treatment of prolactinomas.
Endocr Rev 2006; 27:485.
11. Ono M, Miki N, Amano K, et al. Individualized high-dose cabergoline therapy for
hyperprolactinemic infertility in women with micro- and macroprolactinomas. J Clin
Endocrinol Metab 2010; 95:2672.
12. Radwanska E, McGarrigle HH, Little V, et al. Induction of ovulation in women with
hyperprolactinemic amenorrhea using clomiphene and human chorionic gonadotropin of
bromocriptine. Fertil Steril 1979; 32:187.

13. Ahmed M, al-Dossary E, Woodhouse NJ. Macroprolactinomas with suprasellar extension:

effect of bromocriptine withdrawal during one or more pregnancies. Fertil Steril 1992;
58:492.

14. Melmed S, Casanueva FF, Hoffman AR, et al. Diagnosis and treatment of
hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol
Metab 2011; 96:273.

15. van Roon E, van der Vijver JC, Gerretsen G, et al. Rapid regression of a suprasellar
extending prolactinoma after bromocriptine treatment during pregnancy. Fertil Steril 1981;
36:173.

16. Kuhn E, Weinreich AA, Biermasz NR, et al. Apoplexy of microprolactinomas during
pregnancy: report of five cases and review of the literature. Eur J Endocrinol 2021; 185:99.

17. Bronstein MD, Salgado LR, de Castro Musolino NR. Medical management of pituitary
adenomas: the special case of management of the pregnant woman. Pituitary 2002; 5:99.

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18. Holmgren U, Bergstrand G, Hagenfeldt K, Werner S. Women with prolactinoma--effect of

pregnancy and lactation on serum prolactin and on tumour growth. Acta Endocrinol
(Copenh) 1986; 111:452.
19. Auriemma RS, Perone Y, Di Sarno A, et al. Results of a single-center observational 10-year
survey study on recurrence of hyperprolactinemia after pregnancy and lactation. J Clin
Endocrinol Metab 2013; 98:372.
20. Domingue ME, Devuyst F, Alexopoulou O, et al. Outcome of prolactinoma after pregnancy
and lactation: a study on 73 patients. Clin Endocrinol (Oxf) 2014; 80:642.
Topic 6629 Version 15.0

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GRAPHICS

Treatment of lactotroph microadenomas in women

pursuing pregnancy

PRL: prolactin.

* Cabergoline and bromocriptine are both options. Cabergoline is

better tolerated and more effective than bromocriptine for lowering
PRL. Reassuring pregnancy safety data are available for both drugs.

¶ Clinical evidence of ovulation includes regular intermenstrual

intervals (25 to 35 days), moliminal symptoms (premenstrual breast
tenderness and/or signs and symptoms of premenstrual syndrome).
Biochemical evidence: day 21 serum progesterone concentration >3
ng/mL.

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Δ Evaluate once a trimester for headaches and visual symptoms.

Serum PRL measurements are of no diagnostic value during
pregnancy.

Graphic 134593 Version 2.0

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Pregnancy increases pituitary volume

Pituitary volume, as assessed by magnetic resonance imaging (MRI), in the

nonpregnant state and during pregnancy in 19- to 23-year-old normal
women. There is a progressive increase in pituitary volume during pregnancy.

Data from: Gonzales JG, Elizondo G, Saldivar D, et al. Pituitary gland growth during normal
pregnancy: an in vivo study using magnetic resonance imaging. Am J Med 1988; 85:217.

Graphic 73519 Version 5.0

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Dopamine agonist drugs lower serum prolactin

concentrations in lactotroph adenoma
(prolactinoma)

Serum prolactin concentrations in women with hyperprolactinemic

amenorrhea treated with bromocriptine and cabergoline. Both drugs
lowered serum prolactin concentrations into the normal range (upper
limit of normal equals 20 mcg/L).

Data from: Webster J, Piscitelli MD, Polli A, et al. A comparison of cabergoline and
bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline
Comparative Study Group. N Engl J Med 1994; 331:904.

Graphic 72539 Version 4.0

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Serum prolactin concentrations increase during

pregnancy

Serum prolactin concentrations as a function of time of gestation,

showing the increase in prolactin as pregnancy progresses. The
zone lines represent the range of values that can be seen.

Data from Tyson JE, Ito P, Guyda H, et al. Studies of prolactin secretion in human
pregnancy. Am J Obstet Gynecol 1972; 113:14.

Graphic 82454 Version 2.0

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Serum prolactin and suckling

Serum prolactin concentrations basally and in response to suckling as a

function of time after delivery. Within the first week after delivery, the
basal value is high relative to the nonpregnant state, and there may be
a further increase in response to suckling. Several weeks after delivery,
the basal value is close to that of the nonpregnant state, but there is
still a pronounced increase in response to suckling. Three months after
delivery, the basal value is similar to that of the nonpregnant state, and
there is a minimal response to suckling, if any.

Data from Tyson JE, Ito P, Guyda H, et al. Studies of prolactin secretion in human
pregnancy. Am J Obstet Gynecol 1972; 113:14.

Graphic 59612 Version 2.0

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Contributor Disclosures
Peter J Snyder, MD Grant/Research/Clinical Trial Support: AbbVie [Hypogonadism];Crinetics
[Acromegaly];Novartis [Cushing's];Recordati [Cushing's].
Consultant/Advisory Boards: AbbVie
[Hypogonadism];Novartis [Cushing's];Pfizer [Acromegaly];Teva Pharmaceuticals [Cushing's].
All of the
relevant financial relationships listed have been mitigated. David S Cooper, MD No relevant financial
relationship(s) with ineligible companies to disclose. Charles J Lockwood, MD, MHCM No relevant
financial relationship(s) with ineligible companies to disclose. Kathryn A Martin, MD No relevant financial
relationship(s) with ineligible companies to disclose.

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https://www.uptodate.com/contents/6629/print 19/19