Analysis Of Clinical Characteristics Of Prolactinomas Complicated With Pregnancy

Hyperprolactinemia caused by pituitary Prolactinoma(PRL tumor)can lead to menstrual disorders,infertility and lactation in women of reproductive period.After treatment with dopamine receptor agonists(DAs),it can effectively reduce serum prolactin levels,return to normal menstrual cycle and successfully conceive.This study mainly analyzed the clinical characteristics of patients with pituitary prolactinoma complicated with pregnancy,and explored the evolution of pituitary prolactinoma during pregnancy and the remission rate of postpartum prolactinoma.A total of 80 patients with pituitary prolactin tumor complicated with pregnancy admitted to the outpatient department of endocrinology from January 2013 to October 2020 were included,and 94 pregnancy records of the patients with at least one pregnancy were included.Clinical features,laboratory tests,and imaging tests were collected at the time of diagnosis,treatment,pregnancy,before and after delivery and lactation,and follow-up.Results of this study: Among the 80 pituitary prolactin tumor patients(60 microadenomas and 20 macroadenomas),the serum prolactin level in the macroadenoma group was significantly higher than that in the microadenoma group at diagnosis 270.00(194.75,860.75)vs.126.35(88.00,196.25)ng/ml(P=0.0005).The maximum treatment dose of bromocriptine before pregnancy in the macroadenomas group was 6.25(3.75,7.50)mg/day,which was significantly higher than that in the microadenoma group3.75(2.50,7.19)mg/ day(P=0.025).All 94 pregnancies were treated with DAs,95.75%(90/94)of them were treated with drugs alone.After drug treatment,serum prolactin decreased to 20.9(9.61,39.20)ng/ml,significantly lower than 139.00(93.17,205.50)ng/ml at diagnosis(P <0.0001).Of the 94 pregnancies recorded(80 microadenomas and 14macroadenomas),93.41%(85/91)had a natural pregnancy.Symptomatic tumor growth occurred during pregnancy in 5%(4/80)of microadenomas and 35.71%(5/14)of macroadenomas,with statistically significant differences(P=0.002).In the study,the total miscarriage rate was 8.99%(8/89),and the miscarriage rate in the microadenoma group was 15.79%(6/38)and 5.41%(2/37),respectively,when pregnancy medication was discontinued(P=0.279).In the newborn,only 1 case was a small for gestational age,and the rest were not found deformed infants.In the microadenoma group,93.62%(44/47)chose breastfeeding,while in the macroadenomas group,22.22%(2/9)chose breastfeeding.Compared with the microadenoma patients,the macroadenomas patients were less likely to choose breastfeeding(P < 0.001).In the microadenoma group,only one patient developed headache during breastfeeding,and bromocriptine treatment was resumed.During the follow-up of 60 pregnancies(50microadenomas and 10 macroadenomas),serum prolactin decreased to the normal range(< 30ng/ml)in 22.00%(11 of 50)of the microadenomas,while serum prolactin did not return to normal in the macroadenomas.Conclusion of this study: Pituitary prolactin tumor patients can get pregnant successfully after DAs treatment,and does not increase the adverse pregnancy outcome and the rate of neonatal malformation.Patients with macroadenomas require a larger dose of DAs for effective treatment.Patients with macroadenomas are more likely to develop symptomatic tumor enlargement during pregnancy.22.00% of microadenomas achieved postpartum remission.