title: Management of prolactinomas during pregnancy -- a survey of four Canadian provinces.
abstract: OBJECTIVE
  The guidelines for management of prolactinomas during pregnancy are mostly based on retrospective evidence or expert opinion. We conducted a survey to assess the current trends in management of prolactinomas during pregnancy.
  
  
  METHODS
  A case-based electronic questionnaire was sent in January 2011 to all practicing endocrinologists, in four Canadian provinces: Nova Scotia, New Brunswick, Prince Edward Island and British Columbia with three cases of varying severity; ranging from a microprolactinomas to a large macroprolactinomas compressing the optic chiasm.
  
  
  RESULTS
  There was a considerable diversity among endocrinologists with regards to monitoring and managing prolactinomas during pregnancy. In case of microprolactinomas, 94% of specialists would discontinue dopamine agonist (DA) therapy upon confirmation of pregnancy, 79% would discontinue serum prolactin measurement during pregnancy, and 94% would not perform routine pituitary imaging in the absence of new symptoms whereas 32% would perform regular formal visual field (VF) testing throughout pregnancy. In the case of macroprolactinomas, 65% chose to discontinue DA therapy upon confirmation of pregnancy, 30% would either perform regular MRI during pregnancy or, if serum prolactin was thought to be elevated out of proportion, with clinical judgment and 40% would not perform regular formal VF monitoring during pregnancy. In management of large macroprolactinomas, 82% elected to continue DA therapy whereas 18% chose surgical excision as the treatment of choice. Forty nine percent would perform regular MRI during pregnancy and 94% would perform regular formal VF monitoring during pregnancy.
  
  
  CONCLUSIONS
  Among endocrinologists there is considerable diversity in management of prolactinomas during pregnancy, indicating a need for better consensus and clearer guidelines.
authors.affiliation: Division of Endocrinology and Metabolism, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Mussa H
authors.initials: MH
authors.lastname: Almalki
authors.forename: Ehud
authors.initials: E
authors.lastname: Ur
authors.forename: Michelle
authors.initials: M
authors.lastname: Johnson
authors.forename: David B
authors.initials: DB
authors.lastname: Clarke
authors.forename: Syed A
authors.initials: SA
authors.lastname: Imran
mesh_terms: D000328:Adult; D001955:British Columbia; D002170:Canada; D019468:Disease Management; D018491:Dopamine Agonists / Q000627:therapeutic use; D005260:Female; D006801:Humans; D009509:New Brunswick; D009674:Nova Scotia; D011247:Pregnancy; D011325:Prince Edward Island; D015175:Prolactinoma / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D018491:Dopamine Agonists