Macroprolactinomas with suprasellar extension: effect of bromocriptine withdrawal during one or more pregnancies.
OBJECTIVE
To investigate the effects of bromocriptine withdrawal during one or more pregnancies in patients who presented with pituitary macroprolactinomas with suprasellar extension.


METHODS
Four infertile patients presenting with a macroprolactinoma with suprasellar extension conceived during treatment with bromocriptine on 10 occasions resulting in eight full-term normal deliveries. Treatment was withheld shortly after conception in each pregnancy.


RESULTS
Serum prolactin (PRL) levels fell initially from a mean of 2,776 (range 1,682 to 4,515) to 27 micrograms/L (range 1 to 71) with the development of a partially empty sella in all patients. Recovery of visual field defects occurred in the only affected individual. In case 1, PRL levels remained within the normal range, after bromocriptine withdrawal in the first pregnancy, with the development of an empty sella. Prolactin levels, however, increased substantially in cases 2 to 4. An asymptomatic suprasellar tumor extension returned in cases 2 and 3. After two or more pregnancies (cases 1, 3, and 4), there was a progressive decline in the serum PRL levels. Although still elevated in cases 3 and 4, the PRL levels were considerably below those obtained at presentation or in the first pregnancy. Tumor regression with the development of an empty sella was observed in both these patients as well in their pregnancy or postpartum period.


CONCLUSIONS
Bromocriptine may be safely withdrawn during pregnancy in patients presenting with a macroprolactinoma. With multiple bromocriptine induced pregnancies, PRL levels and tumor size may progressively decrease with the eventual development of an empty sella.
Ahmed
M
M
Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
al-Dossary
E
E
Woodhouse
N J
NJ
D000328:Adult; D001971:Bromocriptine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy*; D011388:Prolactin / Q000097:blood; D015175:Prolactinoma / Q000000981:diagnostic imaging / Q000188:drug therapy*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
D001971:Bromocriptine; D011388:Prolactin