Cabergoline therapy for macroprolactinoma during pregnancy: a case report

Lactogenesis II Onset Following Prolonged Delay in a Mother With a Nonfunctioning Macroadenoma Treated With Cabergoline: A Case Study in Persistence

Introduction

This is a case of a 31-year-old woman who experienced headaches and visual changes in her 15th week of pregnancy and was diagnosed with a macroadenoma.

Treatment

She started a dopamine agonist, a prolactin inhibitor, at that time to treat these symptoms and continued it for 2 weeks after the birth, a total of 13 weeks.

Goal and Outcome

The mother's goal was to provide her own milk for her infant. She began to express milk the day of her infant's birth but obtained only drops for the first 2 months. Using a breast pump and, later, hand expression, this mother was able to finally express more than drops per day. She achieved a full milk supply, 750 mL per day, 21 weeks following delivery, when 2–3 weeks is the average. She continued expressing milk achieving over 900 mL per day when the infant was 24 weeks old.

Conclusion

In this case where cabergoline was discontinued after the birth, persistent pumping and hand expression was enough to initiate milk production. This case study reports this mother's experience with continued expression despite no increasing volumes in the first 2 months. This confirms that with a diagnosis and treatment of this type, milk production is possible with persistent expression.

Prolactinomas, cabergoline, and pregnancy

Hyperprolactinemia, frequently caused by a prolactinoma, is an important cause of infertility among young women. Dopamine agonists (DA) are the treatment of choice. Although cabergoline (CAB) is currently considered the gold standard DA, bromocriptine (BRC) remains the drug of choice for women desiring pregnancy, as it was proven to be safe in more than 6,000 pregnancies. The purpose of this review is to perform a critical evaluation of CAB safety in pregnancy, as it is used by most patients harboring prolactinomas. Although the number of CAB-induced pregnancies (about 800) is still reduced as compared with those under BRC treatment, data in the literature do not point to increase risk of preterm delivery or fetal malformations, comparing to pregnancies induced by BRC and those in the general population. Moreover, CAB use throughout pregnancy was reported in about ten cases, without evidence of any harm to fetal development. Therefore, even though BRC still remains the recommended DA drug for pregnancy induction or use during pregnancy in women with prolactinomas, increasing evidences point to the safety of CAB for this purpose.