Management of Microprolactinoma During Pregnancy
Bromocriptine should be discontinued now that pregnancy is confirmed, as the risk of symptomatic tumor enlargement during pregnancy is very low (2-3%) for microprolactinomas. 1
Rationale for Discontinuation
- For women with microprolactinomas, dopamine agonist therapy should be discontinued as soon as pregnancy is confirmed 2, 1
- The risk of symptomatic tumor enlargement during pregnancy for microprolactinomas is extremely low (2-3%) 1
- Continuing dopamine agonists during pregnancy is generally unnecessary for microprolactinomas 3
Monitoring During Pregnancy
- Clinical follow-up is recommended each trimester 4
- Monitor for symptoms of tumor enlargement such as:
- Headaches
- Visual disturbances
- Visual field changes
- Formal visual field testing only if symptoms develop 1
- MRI (without contrast) is indicated only if symptoms of tumor mass effect develop 3
Management of Potential Complications
- If symptomatic tumor enlargement occurs (which is rare):
Post-Pregnancy Considerations
- Breastfeeding is allowed and has no harmful effect on tumor growth 1
- Dopamine agonist therapy can be postponed as long as breastfeeding is desired 1
- After pregnancy and breastfeeding, reevaluate prolactin levels and tumor status 3
- Approximately 40% of women with microprolactinomas may experience prolonged remission after pregnancy 1
Important Caveats
- While cabergoline has also shown safety in pregnancy (data in >900 cases), bromocriptine remains the preferred dopamine agonist during pregnancy due to more extensive safety data 1, 4
- Regular monitoring is essential as tumor behavior can be unpredictable, even with microprolactinomas
- If visual symptoms develop during pregnancy, prompt evaluation with MRI without contrast is indicated 1
This approach prioritizes both maternal and fetal safety while acknowledging the very low risk of tumor growth complications in microprolactinomas during pregnancy.