Approach to the management of rare clinical presentations of macroprolactinomas in reproductive-aged women.
OBJECTIVE
To describe 2 cases of macroprolactinomas with atypical presentation in women desiring pregnancy that illustrate important considerations in the management approach for macroprolactinomas in reproductive-aged women.


METHODS
Case 1 was a 26-year-old woman referred to our institution for possible tumor resection after pituitary apoplexy during her first pregnancy. Instead, she underwent treatment with cabergoline for a year with goals of normalization of prolactin and decrease in tumor size to <1 cm before trying to conceive. Case 2 was an 18-year-old woman with a macroprolactinoma intolerant to dopamine agonists. She underwent stereotactic radiosurgery, with marked reduction in tumor size and normalization of prolactin levels. She conceived and delivered a healthy infant 3 years after radiosurgery.


CONCLUSIONS
Management of macroprolactinomas in women desiring pregnancy requires careful consideration of alternatives to surgery which could impair pituitary function and fertility and awareness of treatment goals that can minimize the risks for pituitary apoplexy and vision loss during pregnancy. It is important to increase awareness of these options prior to initiation of treatment and conception.
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, 200 First Street SW, Mayo Clinic, Rochester, MN, 55905, United States.
Ana Espinosa
AE
De Ycaza
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, 200 First Street SW, Mayo Clinic, Rochester, MN, 55905 United States.
Alice Y
AY
Chang
Division of Reproductive Endocrinology and Infertility, 200 First Street SW, Mayo Clinic, Rochester, MN, 55905, United States.
Jani R
JR
Jensen
Division of Reproductive Endocrinology and Infertility, 200 First Street SW, Mayo Clinic, Rochester, MN, 55905, United States.
Zaraq
Z
Khan
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, 200 First Street SW, Mayo Clinic, Rochester, MN, 55905, United States.
Dana
D
Erickson
Pituitary apoplexy; Pregnancy; Radiosurgery; United States
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