Prolactinomas are the most common cause of pathological
hyperprolactinemia, leading to central
hypogonadism and, therefore, a frequent etiology of
infertility. Treatment, usually with
dopamine agonist (DA), can reverse
hyperprolactinemia and
hypogonadism, allowing pregnancy in the majority of cases.
Bromocriptine is still the DA of choice for such purpose. Important issues in DA-induced pregnancies include fetal exposition, both malformations and neuropsychological development and
tumor size increase. Regarding
microprolactinomas and intrasellar
macroprolactinomas, DA should be withdrawn as soon as pregnancy is confirmed. In expansive/invasive
macroprolactinomas, DA maintenance should be individualized. Patient follow-up includes periodically clinical evaluation, sellar imaging only indicated in the presence of
tumor mass effects related symptoms. Neurosurgery, both before and during gestation, is indicated in cases in which DA treatment failed. Breastfeeding is usually allowed. As
tumor volume decrease and remission of
hyperprolactinemia may occur after pregnancy, serum
prolactin levels and
tumor status should be reevaluated.