30-year-old married female who has been diagnosed as case of prolactinoma in your hospital. Her MRI Pituitary shows a 5 mm microadenoma. She is currently on bromocriptine and her urine pregnancy test has turned positive. What is the best advice for her?
This is an interdisciplinary question and has been discussed here to widen the scope of discussion. The guidelines are that once a lady with prolactinoma on Bromocriptine conceives, all drug treatment should be stopped to reduce possibility of any teratogenic effect on fetus. Monitor her Prolactin levels and only if headache and visual symptoms develop that bromocriptine can be re-staed. Harrison snap shot is attached for reference. Mechanical contraception should be used through three regular menstrual cycles to allow for conception timing. When pregnancy is confirmed, bromocriptine should be discontinued and PRL levels followed serially, especially if headaches or visual symptoms occur. For women harboring macrodenomas, regular visual field testing is recommended, and the drug should be reinstituted if tumor growth is apparent. Although pituitary MRI may be safe during .
Sta cabergoline
Advise trans-sphenoidal surgery anticipating increase in tumour size in pregnancy
Advise aboion considering teratogenic potential of bromocriptine
Stop Bromocriptine
Disorders of pituitary gland