Macroprolactinomas are rarely seen in women, and pregnancy is a risk factor for tumor growth. More studies are needed to determine appropriate management for macroprolactinoma and pregnancy. The aim of our study is to evaluate effects of treatment with dopamine agonists on macroadenoma before and during pregnancy, safety of dopamine agonists on fetus, post-pregnancy prognosis and long-term results. This is a single center retrospective study. Thirty-four pregnancies occurred in 21 patients under medical therapy. Prolactin levels, treatment results, tumor diameter changes, maternal-fetal outcomes, and disease activity were evaluated. The median tumor size at the time of diagnosis was 15 mm (10–28). Residual adenoma diameter was smaller in those receiving medical therapy longer than one year till the conception (p=0.047). Treatment was discontinued in 28 pregnancies after pregnancy confirmation, and 6 patients were exposed to bromocriptine throughout pregnancy. There was no symptomatic tumor growth during gestation. Among 27 live births, none of the fetuses developed neonatal malformation except for a case of Down syndrome. While early remission rate after pregnancy was 9.5%, this rate reached 33.3% at last follow-up visit. Lowered PRL levels at postpartum period (p=0.040), smaller tumor size at last follow-up visit (p=0.030), and total disappearance of tumor (p=0.026) were the contributor factors for remission. Use of dopamine agonist over one year may reduce the risk of symptomatic tumor growth during pregnancy in patients without invasive or large macroprolactinoma before pregnancy. Exposure to dopamine agonists seems generally safe for the fetus.

中文翻译：

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想要怀孕的巨泌乳素瘤患者的结果：单一中心长达 23 年的随访

巨泌乳素瘤很少见于女性，妊娠是肿瘤生长的危险因素。需要更多的研究来确定对巨泌乳素瘤和妊娠的适当管理。我们研究的目的是评估多巴胺激动剂对妊娠前和妊娠期间大腺瘤的治疗效果、多巴胺激动剂对胎儿的安全性、妊娠后预后和长期结果。这是一项单中心回顾性研究。21 名接受药物治疗的患者共妊娠 34 次。评估催乳素水平、治疗结果、肿瘤直径变化、母胎结局和疾病活动度。诊断时的中位肿瘤大小为 15 mm (10-28)。在受孕前接受药物治疗超过一年的患者中，残余腺瘤直径较小（p = 0.047）。28 例妊娠确认后停止治疗，6 例患者在整个妊娠期间均暴露于溴隐亭。妊娠期间没有有症状的肿瘤生长。在 27 例活产儿中，除 1 例唐氏综合症外，没有任何胎儿出现新生儿畸形。妊娠后早期缓解率为9.5%，末次随访时达到33.3%。产后 PRL 水平降低 (p=0.040)、最后一次随访时肿瘤体积较小 (p=0.030) 和肿瘤完全消失 (p=0.026) 是缓解的促成因素。对于怀孕前没有浸润性或大的巨泌乳素瘤的患者，使用多巴胺激动剂一年以上可能会降低怀孕期间出现症状性肿瘤生长的风险。暴露于多巴胺激动剂似乎对胎儿通常是安全的。