Document Detail


Prolactinoma and estrogens: pregnancy, contraception and hormonal replacement therapy.
MedLine Citation:
PMID:  17540335     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The stimulatory role of estrogen on prolactin secretion and on proliferation of lactotropic cells is well established in terms of physiology but could this phenomenon be extended to include harmful effects of estrogens on prolactinoma? The aim of this review is to provide an up-to-date assessment of this subject with regard to pregnancy, use of contraceptive pills and postmenopausal hormone replacement therapy. Dopamine agonists allow women presenting prolactinoma to recover their ovulation cycles and become pregnant. There is no adverse data concerning the safety of dopamine agonists such as bromocriptine, if the woman is treated during the first trimester of pregnancy but there is little information regarding the most recent treatments such as cabergoline or quinagolide. In women with microadenomas, pregnancy generally has little impact on their adenoma, delivery is normal and breast-feeding is allowed. Concerning macroprolactinomas, tumor progression during pregnancy is possible and endocrine follow-up remains necessary. Contraceptive pills containing estrogen and progestins are currently the best-tolerated and the most effective contraception. This type of contraceptive has long been avoided in patients presenting prolactinoma. While the literature has little to say on this subject and provides no adverse information, professional experience suggests that this attitude should be amended and that women presenting microprolactinoma should be allowed to use current contraceptive pills (containing 30 microg or less of ethinyl estradiol). The most important problem to overcome with this type of prescription, which masks the clinical consequences of hyperprolactinemia, is the possibility of overlooking hypophyseal disease that could result from this approach. The problem of macroprolactinoma is different; the possibility of prescribing contraceptive pills must be evaluated on a case-by-case basis and the impact of the drug on the adenoma must be very closely monitored. Estrogen replacement therapy in patients presenting hypogonadism should be attempted in patients with a history of prolactinoma and standard-monitoring precautions should be taken. In menopausal women, when replacement therapy is desirable, the presence of a microprolactinoma should not by itself avoid this prescription.
Authors:
S Christin-Maître; B Delemer; P Touraine; J Young
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Publication Detail:
Type:  Journal Article; Review     Date:  2007-05-30
Journal Detail:
Title:  Annales d'endocrinologie     Volume:  68     ISSN:  0003-4266     ISO Abbreviation:  Ann. Endocrinol. (Paris)     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-07-30     Completed Date:  2007-10-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0116744     Medline TA:  Ann Endocrinol (Paris)     Country:  France    
Other Details:
Languages:  eng     Pagination:  106-12     Citation Subset:  IM    
Affiliation:
Service d'endocrinologie, hôpital Saint-Antoine, 75571 Paris cedex 12, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Contraceptives, Oral, Hormonal / adverse effects*
Estrogen Replacement Therapy / adverse effects*
Estrogens / metabolism,  pharmacology,  physiology*
Female
Humans
Middle Aged
Pituitary Neoplasms / chemically induced,  etiology*,  physiopathology
Pregnancy / physiology*
Prolactin / metabolism
Prolactinoma / chemically induced,  etiology*,  physiopathology
Chemical
Reg. No./Substance:
0/Contraceptives, Oral, Hormonal; 0/Estrogens; 9002-62-4/Prolactin

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