Due to lactotroph hyperplasia in pregnancy, there is concern for enlargement of prolactinomas in pregnancy. Because microadenomas are not likely to enlarge during pregnancy, dopamine agonist therapy should be discontinued when pregnancy is discovered. However, patients who have macroadenomas without prior surgical or radiation therapy have a significant risk of tumor growth. Surgical tumor debulking prior to pregnancy or dopamine agonist therapy throughout pregnancy may be required in these patients. Bromocriptine is the preferred agent in pregnancy.
Patients with macroadenomas should be monitored with visual field testing each trimester while those with microadenomas can be monitored clinically. Headaches or visual field changes should prompt a noncontrast pituitary MRI.
