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Sin título de diapositiva
 

Sin título de diapositiva

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    Sin título de diapositiva Sin título de diapositiva Presentation Transcript

    • Semin Perinatol. 1998 Dec;22(6):457-70. Related Articles, Links Pituitary diseases in pregnancy. Molitch ME. Center for Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Medical School, Chicago, IL 60611, USA. Pituitary adenomas are the most common pituitary disorder affecting pregnancy, and prolactinomas are the most common of the hormone-secreting pituitary adenomas. Hyperprolactinemia must be corrected to allow ovulation and fertility. Bromocriptine has been shown to be safe for use during early gestation. There is less than a 2% risk of microprolactinoma enlargement during pregnancy but a greater than 15% risk of symptomatic enlargement of a macroprolactinoma. Treatment options for patients with macroadenomas include stopping bromocriptine when pregnancy is diagnosed and reinstituting with tumor enlargement, continuous bromocriptine throughout pregnancy, and prepregnancy tumor debulking by surgery. The diagnosis of acromegaly may be difficult to make during pregnancy and relies, in part, on the persistence of the normal pulsatile secretion of growth hormone and loss of this secretory characteristic with a tumor. The growth hormone oversecretion may exacerbate tendencies to gestational diabetes, fluid retention, and hypertension. Treatment for acromegaly and other tumors generally may be deferred until after delivery. There are rare reports of enlargement of clinically nonfunctioning and growth hormone secreting tumors during pregnancy, and surveillance is needed. Tumors may need to be differentiated from lymphocytic hypophysitis. Patients with chronic hypopituitarism usually will need treatment with gonadotropins or pulsatile GnRH to become pregnant and may need increased steroid coverage during labor and delivery. Hypopituitarism developing during pregnancy is usually caused by lymphocytic hypophysitis and usually also will require steroid replacement therapy. Hypopituitarism arising postpartum may be caused by either lymphocytic hypophysitis or Sheehan's syndrome, and the latter may present as an acute or chronic syndrome. Borderline diabetes insipidus may manifest during pregnancy because of increased vasopressin degradation caused by markedly increased levels of placental vasopressinase. Treatment with desmopressin usually is satisfactory. Patients presenting with either anterior or posterior pituitary insufficiency in the peripartum period should always be evaluated for function of the other portion of the pituitary.
    • Semin Perinatol. 1998 Dec;22(6):457-70. Related Articles, Links Pituitary diseases in pregnancy. Molitch ME. Center for Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Medical School, Chicago, IL 60611, USA. Pituitary adenomas are the most common pituitary disorder affecting pregnancy, and prolactinomas are the most common of the hormone-secreting pituitary adenomas. Hyperprolactinemia must be corrected to allow ovulation and fertility. Bromocriptine has been shown to be safe for use during early gestation. There is less than a 2% risk of microprolactinoma enlargement during pregnancy but a greater than 15% risk of symptomatic enlargement El 2% de los microadenomas crecen of a macroprolactinoma. Treatment options for patients with macroadenomas include stopping bromocriptine when durante el embarazo pregnancy is diagnosed and reinstituting with tumor enlargement, continuous bromocriptine throughout pregnancy, and prepregnancy tumor debulking by surgery. The diagnosis of acromegaly may be difficult to make during pregnancy and relies, in part, on the persistence of the normal pulsatile secretion of growth hormone and loss of this secretory characteristic with a tumor. The growth hormone oversecretion may exacerbate tendencies to gestational diabetes, fluid retention, and hypertension. Treatment for acromegaly and other tumors generally may be deferred until after delivery. There are rare reports of enlargement of clinically nonfunctioning and growth hormone secreting tumors during pregnancy, and surveillance is needed. Tumors may need to be differentiated from lymphocytic hypophysitis. Patients with chronic hypopituitarism usually will need treatment El 15% de los macroadenomas with gonadotropins or pulsatile GnRH to become pregnant and may need increased steroid coverage during labor and delivery. Hypopituitarism developing during pregnancy is usually caused by lymphocytic hypophysitis and lo hacen usually also will require steroid replacement therapy. Hypopituitarism arising postpartum may be caused by either lymphocytic hypophysitis or Sheehan's syndrome, and the latter may present as an acute or chronic syndrome. Borderline diabetes insipidus may manifest during pregnancy because of increased vasopressin degradation caused by markedly increased levels of placental vasopressinase. Treatment with desmopressin usually is satisfactory. Patients presenting with either anterior or posterior pituitary insufficiency in the peripartum period should always be evaluated for function of the other portion of the pituitary.
    • Semin Perinatol. 1998 Dec;22(6):457-70. Related Articles, Links Pituitary diseases in pregnancy. Molitch ME. Center for Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Medical School, Chicago, IL 60611, USA. Pituitary adenomas are the most common pituitary disorder affecting pregnancy, and prolactinomas are the most common of the hormone-secreting pituitary adenomas. Hyperprolactinemia mustes corrected to allow ovulation A veces, durante el embarazo be and fertility. Bromocriptine has been shown to be safe for use during early gestation. There is less than a 2% risk of microprolactinoma enlargement during pregnancy but a el tratamiento of symptomatic enlargement necesario proseguir greater than 15% risk El 2% de los microadenomas patients with macroadenomas include stopping bromocriptine when con for crecen of a macroprolactinoma. Treatment options bromocriptina o recurrir durante el embarazo cirugía hipofisaria pregnancy is diagnosed and reinstituting with tumor enlargement, continuous bromocriptine throughout pregnancy, a la and prepregnancy tumor debulking by surgery. The diagnosis of acromegaly may be difficult to make during pregnancy and relies, in part, on the persistence of the normal pulsatile secretion of growth hormone and loss of this secretory characteristic with a tumor. The growth hormone oversecretion may exacerbate tendencies to gestational diabetes, fluid retention, and hypertension. Treatment for acromegaly and other tumors generally may be deferred until after delivery. There are rare reports of enlargement of clinically nonfunctioning and growth hormone secreting tumors during pregnancy, and surveillance is needed. Tumors may need to be differentiated from lymphocytic hypophysitis. Patients with chronic hypopituitarism usually will need treatment El 15% de los macroadenomas with gonadotropins or pulsatile GnRH to become pregnant and may need increased steroid coverage during labor and delivery. Hypopituitarism developing during pregnancy is usually caused by lymphocytic hypophysitis and lo hacen usually also will require steroid replacement therapy. Hypopituitarism arising postpartum may be caused by either lymphocytic hypophysitis or Sheehan's syndrome, and the latter may present as an acute or chronic syndrome. Borderline diabetes insipidus may manifest during pregnancy because of increased vasopressin degradation caused by markedly increased levels of placental vasopressinase. Treatment with desmopressin usually is satisfactory. Patients presenting with either anterior or posterior pituitary insufficiency in the peripartum period should always be evaluated for function of the other portion of the pituitary.
    • : Pituitary. 2002;5(2):99-107. Related Articles, Links Medical management of pituitary adenomas: the special case of management of the pregnant woman. Bronstein MD, Salgado LR, de Castro Musolino NR. Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of S. Paulo Medical School, SP, Brazil. mdbronstein@uol.com.br The development of efficacious surgical and medical therapies for pituitary adenomas as well as the improvement of hormone therapy for ovulation induction has made pregnancy possible for women harboring pituitary tumors. However, gestational risks due to the possibility of tumor growth during pregnancy, mainly in women with macroadenomas, raise a concern. Bromocriptine has a well-established role for prolactinoma treatment before and during pregnancy, even when a symptomatic tumor increase occurs. It can also be used in acromegaly, despite its poorer results. Somatostatin analogs have been used in acromegaly even during pregnancy with uneventful outcomes, but their safety in pregnancy is not well established, yet. The largest experience with medical treatment for Cushing's disease during pregnancy involves metyrapone, a steroidogenesis inhibitor, without descriptions of congenital abnormalities. Concerning clinically non-functioning pituitary tumors, ovulation induction or even in vitro fertilization are frequently needed. The purpose of this review is to provide an update on therapeutic strategies to restore fertility as well as gestational and post-gestational management of patients with pituitary adenomas, focusing mainly on the role of medical treatment for different tumor types. PMID: 12675507 [PubMed - in process]
    • : Pituitary. 2002;5(2):99-107. Related Articles, Links Medical management of pituitary adenomas: the special case of management of the pregnant woman. Bronstein MD, Salgado LR, de Castro Musolino NR. Neuroendocrinebromocriptina ha La Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of S. Paulo Medical School, SP, Brazil. mdbronstein@uol.com.br demostrado su utilidad durante el embarazo The development of efficacious surgical and medical therapies for pituitary adenomas as well as the improvement of hormone therapy for ovulation induction has made pregnancy possible for women harboring pituitary tumors. However, gestational risks necesaria cuando es due to the possibility of tumor growth during pregnancy, mainly in women with macroadenomas, raise a concern. Bromocriptine has a well-established role for prolactinoma treatment before and during pregnancy, even when a symptomatic tumor increase occurs. It can also be used in acromegaly, despite its poorer results. Somatostatin analogs have been used in acromegaly even during pregnancy with uneventful outcomes, but their safety in pregnancy is not well established, yet. The largest experience with medical treatment for Cushing's disease during pregnancy involves metyrapone, a steroidogenesis inhibitor, Aún para el tratamiento de without descriptions of congenital abnormalities. Concerning clinically non-functioning pituitary tumors, ovulation induction or even in vitro fertilization are frequently needed. The adenomas que crezcan purpose of this review is to provide an update on therapeutic strategies to restore fertility as well as gestational and post-gestational management of patients a lo largo de la gestación with pituitary adenomas, focusing mainly on the role of medical treatment for different tumor types. PMID: 12675507 [PubMed - in process]
    • : Neurochirurgie. 2000 Apr;46(2):88-94. Related Articles, Links [Pituitary disorders in pregnancy] Jan M, Destrieux C. Service de Neurochirurgie, CHU Bretonneau, 37044 Tours Cedex 01. During pregnancy there is a normal increase in the volume of the anterior pituitary as demonstrated by MRI and hormone secretions which increase (PRL) or decrease (FSH, LH). During pregnancy pituitary adenomas, especially prolactinomas, may evolve as in non-pregnant women (microadenomas) or differently (macroadenomas). In 35 % of cases macroprolactinomas worsen during pregnancy making their medico-surgical management mandatory prior to pregnancy. Inversely, pregnancy occurring in a subject with a microprolactinoma never induces severe local complications so such tumors may be managed surgically or medically. Surgery should be performed for acromegaly or Cushing's disease before or early in pregnancy. Subacute pituitary apoplexy (intratumoral hemorrhage) occurs in about 10 to 15 % of adenomas but, generally speaking, clinical symptoms remain mild in pregnant women. Lymphocytic hypophysitis occurs at the end of pregnancy, or during the post-partum period. The association of complete pan-hypopituitarism and hypersignal on MRI examination may mimic hypophyseal apoplexy and could lead to and inappropriate surgical procedure.
    • : Neurochirurgie. 2000 Apr;46(2):88-94. Related Articles, Links [Pituitary disorders in pregnancy] Jan M, Destrieux C. El 35% de los macroadenomas Service de Neurochirurgie, CHU Bretonneau, 37044 Tours Cedex 01. empeoran durante el During pregnancy there is a normal increase in the volume of the anterior pituitary as demonstrated by MRI and embarazo hormone secretions which increase (PRL) or decrease (FSH, LH). During pregnancy pituitary adenomas, especially prolactinomas, may evolve as in non-pregnant women (microadenomas) or differently (macroadenomas). In 35 % of cases macroprolactinomas worsen during pregnancy making their medico-surgical management mandatory prior to pregnancy. Inversely, pregnancy occurring in a subject with a microprolactinoma never induces severe local complications so such tumors may be managed surgically or medically. Surgerydebe be performed for Por ello should realizarse su completo tratamiento acromegaly or Cushing's disease before or early in pregnancy. Subacute pituitary apoplexy (intratumoral hemorrhage) occurs in about 10 to 15 % of adenomas but, generally speaking, clinical symptoms remain mild in pregnant women. Lymphocytic hypophysitis occurs at the end of pregnancy, or during the post-partum de médico/quirúrgico antes period. la gestación The association of complete pan-hypopituitarism and hypersignal on MRI examination may mimic hypophyseal apoplexy and could lead to and inappropriate surgical procedure.
    • : Neurochirurgie. 2000 Apr;46(2):88-94. Related Articles, Links [Pituitary disorders in pregnancy] Jan M, Destrieux C. El 35% de los macroadenomas Service de Neurochirurgie, CHU Bretonneau, 37044 Tours Cedex 01. empeoran durante el el contrario, los microadenomas Por During pregnancy there is a normal increase in the volume of the anterior pituitary as demonstrated by MRI and embarazo rara vez son un problema hormone secretions which increase (PRL) or decrease (FSH, LH). During pregnancy pituitary adenomas, especially prolactinomas, may evolve as in non-pregnantdurante el embarazo women (microadenomas) or differently (macroadenomas). In 35 % of cases macroprolactinomas worsen during pregnancy making their medico-surgical management mandatory prior to pregnancy. Inversely, pregnancy occurring in a subject with a microprolactinoma never induces severe local complications so such tumors may be managed surgically or medically. Surgerydebe be performed for Por ello should realizarse su completo tratamiento acromegaly or Cushing's disease before or early in pregnancy. Subacute pituitary apoplexy (intratumoral hemorrhage) occurs in about 10 to 15 % of adenomas but, generally speaking, clinical symptoms remain mild in pregnant women. Lymphocytic hypophysitis occurs at the end of pregnancy, or during the post-partum de médico/quirúrgico antes period. la gestación The association of complete pan-hypopituitarism and hypersignal on MRI examination may mimic hypophyseal apoplexy and could lead to and inappropriate surgical procedure.
    • : Gynecol Endocrinol. 1996 Apr;10(2):91-4. Related Articles, Links Relative resistance of a macroprolactinoma to bromocriptine therapy during pregnancy. Shanis BS, Check JH. Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, Cooper Hospital/University Medical Center, USA. A woman presented with a pituitary macroadenoma with extensive suprasellar extension. Her initial response to bromocriptine therapy was good, allowing subsequent trans-sphenoidal surgical treatment. The tumor grew during pregnancy despite continued bromocriptine therapy, but it returned to prepregnancy size postdelivery. There have been conflicting reports regarding the growth of pituitary tumors in pregnancy. Most recognize that some growth may occur, but only a small percentage of patients are reported to become symptomatic from the growth. Resistance to bromocriptine has been reported in non-pregnant patients. Patients who have had surgery or radiation therapy and did not receive bromocriptine treatment during pregnancy have been reported to have symptomatic growth of their residual tumor. This case demonstrates an unusual tumor that became resistant to bromocriptine during pregnancy, but whose sensitivity to the drug returned postdelivery. PMID: 8701792 [PubMed - indexed for MEDLINE]
    • : Gynecol Endocrinol. 1996 Apr;10(2):91-4. Related Articles, Links Relative resistance of a macroprolactinoma to bromocriptine therapy during pregnancy. Se ha descripto la resistencia a la Shanis BS, Check JH. fuera del bromocriptina embarazo Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, Cooper Hospital/University Medical Center, USA. Se describe el caso de una paciente A woman presented with a pituitary macroadenoma with extensive suprasellar extension. Her initial response to que recibió tratamiento médico bromocriptine therapy was good, allowing subsequent trans-sphenoidal surgical treatment. The tumor grew during pregnancy despite continued bromocriptine therapy, but it returned to prepregnancy size postdelivery. There have been conflicting reports regarding the growth of pituitary quirurgico por un macro that some y tumors in pregnancy. Most recognize growth may occur, but only a small percentage of patients are reported to become previo al from the prolactinoma symptomatic growth. Resistance to bromocriptine has been reported in non-pregnant patients. Patients who have had surgery emabaro or radiation therapy and did not receive bromocriptine treatment during pregnancy have been reported to have symptomatic growth of their residual tumor. This case demonstrates an unusual tumor that became resistant to bromocriptine during pregnancy, but whose sensitivity to the drug returned postdelivery. PMID: 8701792 [PubMed - indexed for MEDLINE]
    • : Gynecol Endocrinol. 1996 Apr;10(2):91-4. Related Articles, Links Relative resistance of a macroprolactinoma to bromocriptine therapy during pregnancy. El tumor residual creció nuevamente Se ha descripto la resistencia a la Shanis BS, Check JH. fuera deldurante el embarazo demostrando bromocriptina refringencia al tratamiento embarazo Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey, Robert Wood continuado con bromocriptina Johnson Medical School at Camden, Cooper Hospital/University Medical Center, USA. durante la gestacion Se describe el caso de una paciente A woman presented with a pituitary macroadenoma with extensive suprasellar extension. Her initial response to que recibió tratamiento médico bromocriptine therapy was good, allowing subsequent trans-sphenoidal surgical treatment. The tumor grew during pregnancy despite continued bromocriptine therapy, but it returned to prepregnancy size postdelivery. There have been conflicting reports regarding the growth of pituitary quirurgico por un macro that some y tumors in pregnancy. Most recognize growth may occur, but only a small percentage of patients are reported to become previo al from the prolactinoma symptomatic growth. Resistance to bromocriptine has been reported in non-pregnant patients. Patients who have had surgery emabaro or radiation therapy and did not receive bromocriptine treatment during pregnancy have been reported to have symptomatic growth of their residual tumor. This case demonstrates an unusual tumor that became resistant to bromocriptine during pregnancy, but whose sensitivity to the drug returned postdelivery. PMID: 8701792 [PubMed - indexed for MEDLINE]
    • : Gynecol Endocrinol. 1996 Apr;10(2):91-4. Related Articles, Links Al concluír la misma el tumor Relative resistance hizo nuevamente se of a macroprolactinoma to bromocriptine therapy during pregnancy. sensible a la bromocriptina El tumor residual creció nuevamente Se ha descripto la resistencia a la Shanis BS, Check JH. fuera deldurante el embarazo demostrando bromocriptina refringencia al tratamiento embarazo Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey, Robert Wood continuado con bromocriptina Johnson Medical School at Camden, Cooper Hospital/University Medical Center, USA. durante la gestacion Se describe el caso de una paciente A woman presented with a pituitary macroadenoma with extensive suprasellar extension. Her initial response to que recibió tratamiento médico bromocriptine therapy was good, allowing subsequent trans-sphenoidal surgical treatment. The tumor grew during pregnancy despite continued bromocriptine therapy, but it returned to prepregnancy size postdelivery. There have been conflicting reports regarding the growth of pituitary quirurgico por un macro that some y tumors in pregnancy. Most recognize growth may occur, but only a small percentage of patients are reported to become previo al from the prolactinoma symptomatic growth. Resistance to bromocriptine has been reported in non-pregnant patients. Patients who have had surgery emabaro or radiation therapy and did not receive bromocriptine treatment during pregnancy have been reported to have symptomatic growth of their residual tumor. This case demonstrates an unusual tumor that became resistant to bromocriptine during pregnancy, but whose sensitivity to the drug returned postdelivery. PMID: 8701792 [PubMed - indexed for MEDLINE]
    • Pituitary. 2001 Aug;4(3):179-85. Related Articles, Links Successful treatment of a large macroprolactinoma with cabergoline during pregnancy. Liu C, Tyrrell JB. Department of Medicine, University of California, San Francisco, 94143-0326, USA. cliu@itsa.ucsf.edu We report a pregnant woman with a large macroprolactinoma successfully treated with cabergoline after a suboptimal response to bromocriptine. A 7 week pregnant woman with a history of a prolactinoma presented to the endocrine clinic with the complaints of headaches and nausea. She had a prolactin level of 65 microg/L 1 1/2 weeks following her last menstrual period. Bromocriptine was discontinued at 6 weeks gestation when pregnancy was confirmed. A PRL concentration was 1899 microg/L (non-pregnant normal range 1.39-24.20 microg/L, the mean peak levels during pregnancy reported from the literature are 200-210 microg/L) at 7 weeks gestation, and a repeat was 2197 microg/L. An MRI showed a 3 x 2.2 x 2.5 cm seller mass abutting the optic chiasm and displacing the optic nerves superiorly; the visual field testing was normal. Bromocriptine was reinitiated and the patient responded initially with decreasing headaches and declining PRL concentrations to 1488 microg/L at 15 weeks gestation. However, PRL increased to 1836 microg/L at 16 weeks and remained elevated despite bromocriptine 2.5 mg three times a day; in addition, she complained of severe nausea, vomiting, and persistent headaches. Cabergoline was added at 18 weeks gestation. PRL decreased dramatically from 1710 to 859 microg/L in 1 week, and to 488 microg/L within 4 weeks. A repeat MRI showed more than 30% reduction in tumor size. Bromocriptine was discontinued at 24 weeks gestation; she was maintained on cabergoline 0.5 mg twice a week without complaints. PRL levels ranged from 190 to 278 microg/L during the last 10 weeks of pregnancy. She had a C-section electively at 37 weeks gestation and delivered a healthy baby. Management options in this patient and during pregnancy are discussed. PMID: 12138991 [PubMed - indexed for MEDLINE]
    • Pituitary. 2001 Aug;4(3):179-85. Related Articles, Links Successful treatment of a large macroprolactinoma with cabergoline during pregnancy. Liu C, Tyrrell JB. Department of Medicine, University of California, San Francisco, 94143-0326, USA. cliu@itsa.ucsf.edu We report a pregnant woman with a large macroprolactinoma successfully treated with cabergoline after a suboptimal response to bromocriptine. A 7 week pregnant woman with a history of a prolactinoma presented Se presenta el caso de una to the endocrine clinic with the complaints of headaches and nausea. She had a prolactin level of 65 microg/L 1 1/2 weeks following her lastpresentó paciente que menstrual period. Bromocriptine was discontinued at 6 weeks gestation when pregnancy was confirmed. A PRL concentration was 1899 microg/L (non-pregnant normal range 1.39-24.20 hiperprolactinemia en microg/L, the mean peak levels during pregnancy reported from the literature are 200-210 microg/L) at 7 weeks gestation,el embarazo 2197 microg/L. An MRI showed a 3 x 2.2 x 2.5 cm seller mass abutting the and a repeat was optic chiasm and displacing the optic nerves superiorly; the visual field testing was normal. Bromocriptine was Se reinstaló el tratamiento que reinitiated and the patient responded initially with decreasing headaches and declining PRL concentrations to había recibido previamente: 1488 microg/L at 15 weeks gestation. However, PRL increased to 1836 microg/L at 16 weeks and remained elevated despite bromocriptine 2.5 mg three times a day; in addition, she complained of severe nausea, bromocriptina vomiting, and persistent headaches. Cabergoline was added at 18 weeks gestation. PRL decreased dramatically from 1710 to 859 microg/L in 1 week, and to 488 microg/L within 4 weeks. A repeat MRI showed more than 30% reduction in tumor size. Bromocriptine was discontinued at 24 weeks gestation; she was maintained on cabergoline 0.5 mg twice a week without complaints. PRL levels ranged from 190 to 278 microg/L during the last 10 weeks of pregnancy. She had a C-section electively at 37 weeks gestation and delivered a healthy baby. Management options in this patient and during pregnancy are discussed. PMID: 12138991 [PubMed - indexed for MEDLINE]
    • Pituitary. 2001 Aug;4(3):179-85. Related Articles, Links Successful treatment of a large macroprolactinoma with cabergoline during pregnancy. Liu C, Tyrrell JB. A las 15 semanas la paciente dejó Department of Medicine, University of California, San Francisco,a la de responder 94143-0326, USA. cliu@itsa.ucsf.edu bromocriptina y presentó We report a pregnant woman with a large macroprolactinoma successfully treated with cabergoline after a Se presenta el caso de una de expansión tumoral síntomas suboptimal response to bromocriptine. A 7 week pregnant woman with a history of a prolactinoma presented to the endocrine clinic with the complaints of headaches and nausea. She had a prolactin level of 65 microg/L 1 1/2 weeks following her lastpresentó paciente que menstrual period. Bromocriptine was discontinued at 6 weeks gestation when pregnancy was confirmed. A PRL concentration was 1899 microg/L (non-pregnant normal range 1.39-24.20 hiperprolactinemia en microg/L, the mean peak levels during pregnancy reported from the literature are 200-210 microg/L) at 7 weeks gestation,el embarazo 2197 microg/L. An MRI showed a 3 x 2.2 x 2.5 cm seller mass abutting the and a repeat was optic chiasm and displacing the optic nerves superiorly; the visual field testing was normal. Bromocriptine was Se reinstaló el tratamiento que reinitiated and the patient responded initially with decreasing headaches and declining PRL concentrations to había recibido previamente: 1488 microg/L at 15 weeks gestation. However, PRL increased to 1836 microg/L at 16 weeks and remained elevated despite bromocriptine 2.5 mg three times a day; in addition, she complained of severe nausea, bromocriptina vomiting, and persistent headaches. Cabergoline was added at 18 weeks gestation. PRL decreased dramatically from 1710 to 859 microg/L in 1 week, and to 488 microg/L within 4 weeks. A repeat MRI showed more than 30% reduction in tumor size. Bromocriptine was discontinued at 24 weeks gestation; she was maintained on cabergoline 0.5 mg twice a week without complaints. PRL levels ranged from 190 to 278 microg/L during the last 10 weeks of pregnancy. She had a C-section electively at 37 weeks gestation and delivered a healthy baby. Management options in this patient and during pregnancy are discussed. PMID: 12138991 [PubMed - indexed for MEDLINE]
    • Pituitary. 2001 Aug;4(3):179-85. Related Articles, Links Successful treatment of a large macroprolactinoma with cabergoline during pregnancy. Liu C, Tyrrell JB. A las 15 semanas la paciente dejó Department of Medicine, University of California, San Francisco,a la de responder 94143-0326, USA. cliu@itsa.ucsf.edu Se cambió la droga por bromocriptina y presentó We report a pregnant womancabergolina con with a large macroprolactinoma successfully treated with cabergoline after a Se presenta el caso de una de expansión tumoral síntomas buen resultado terapéutico suboptimal response to bromocriptine. A 7 week pregnant woman with a history of a prolactinoma presented to the endocrine clinic with the complaints of headaches and nausea. She had a prolactin level of 65 microg/L 1 1/2 weeks following her lastpresentó paciente que menstrual period. Bromocriptine was discontinued at 6 weeks gestation when pregnancy was confirmed. A PRL concentration was 1899 microg/L (non-pregnant normal range 1.39-24.20 hiperprolactinemia en microg/L, the mean peak levels during pregnancy reported from the literature are 200-210 microg/L) at 7 weeks gestation,el embarazo 2197 microg/L. An MRI showed a 3 x 2.2 x 2.5 cm seller mass abutting the and a repeat was optic chiasm and displacing the optic nerves superiorly; the visual field testing was normal. Bromocriptine was Se reinstaló el tratamiento que reinitiated and the patient responded initially with decreasing headaches and declining PRL concentrations to había recibido previamente: 1488 microg/L at 15 weeks gestation. However, PRL increased to 1836 microg/L at 16 weeks and remained elevated despite bromocriptine 2.5 mg three times a day; in addition, she complained of severe nausea, bromocriptina vomiting, and persistent headaches. Cabergoline was added at 18 weeks gestation. PRL decreased dramatically from 1710 to 859 microg/L in 1 week, and to 488 microg/L within 4 weeks. A repeat MRI showed more than 30% reduction in tumor size. Bromocriptine was discontinued at 24 weeks gestation; she was maintained on cabergoline 0.5 mg twice a week without complaints. PRL levels ranged from 190 to 278 microg/L during the last 10 weeks of pregnancy. She had a C-section electively at 37 weeks gestation and delivered a healthy baby. Management options in this patient and during pregnancy are discussed. PMID: 12138991 [PubMed - indexed for MEDLINE]
    • : Int J Gynaecol Obstet. 1986 Jun;24(3):209-15. Related Articles, Links Rapid regression through bromocriptine therapy of a suprasellar extending prolactinoma during pregnancy. Tan SL, Jacobs HS. A 29-year-old woman is described who presented with amenorrhea and galactorrhea with a large prolactinoma which regressed on bromocriptine therapy. Treatment with bromocriptine was stopped when pregnancy was diagnosed but 6 weeks later the prolactinoma had regrown with suprasellar extension and lateral invasion of the cavernous sinus. When treatment with bromocriptine was reinstituted symptoms subsided within 24 h and serum prolactin concentrations fell from 54,000 mM/l to 2800 mU/l within 5 days and 500 mU/l 2 days after that. Pregnancy proceeded without complications and she entered spontaneous labor at term and delivered a healthy baby. One year after delivery, on treatment with bromocriptine, her serum prolactin concentration remains within the normal range and the CT scan shows persistence of a small prolactinoma, confined to the pituitary fossa. Bromocriptine should be the primary treatment for prolactinomas regardless of tumor size and may be safely stopped when pregnancy is desired. If pituitary tumor complications occur during pregnancy, reintroduction of treatment with bromocriptine should again be the treatment of choice. PMID: 2880760 [PubMed - indexed for MEDLINE]
    • : Int J Gynaecol Obstet. 1986 Jun;24(3):209-15. Related Articles, Links Rapid regression through bromocriptine therapy of a suprasellar extending prolactinoma during pregnancy. Se suspendió el tratamiento con bromocriptina a una Tan SL, Jacobs HS. a. paciente de 29 cuando embarazó A 29-year-old woman is described who presented with amenorrhea and galactorrhea with a large prolactinoma which regressed on bromocriptine therapy. Treatment with bromocriptine was stopped when pregnancy was diagnosed but 6 weeks later the prolactinoma had regrownA las 6 semanas el tumor invasion of the with suprasellar extension and lateral cavernous sinus. When treatment with bromocriptine was reinstituted symptoms subsided within 24 h and serum creció rápidamente prolactin concentrations fell from 54,000 mM/l to 2800 mU/l within 5 days and 500 mU/l 2 days after that. Pregnancy proceeded without complications and she enteredextendiéndose a regiones spontaneous labor at term and delivered a healthy baby. One year after delivery, on treatment with bromocriptine, her serum prolactin concentration remains supraselares within the normal range and the CT scan shows persistence of a small prolactinoma, confined to the pituitary fossa. Bromocriptine should be the primary treatment for prolactinomas regardless of tumor size and may be safely stopped when pregnancy is desired. If pituitary tumor complications occur during pregnancy, reintroduction of treatment with bromocriptine should again be the treatment of choice. PMID: 2880760 [PubMed - indexed for MEDLINE]
    • : Int J Gynaecol Obstet. 1986 Jun;24(3):209-15. Related Articles, Links Rapid regression through bromocriptine therapy of a suprasellar extending prolactinoma during pregnancy. Se suspendió el tratamiento con bromocriptina a una Tan SL, Jacobs HS. a. paciente de 29 cuando embarazó nivel de prolactina superó A 29-year-old woman is described who presented with amenorrhea and galactorrhea with a large prolactinoma El which regressed on bromocriptine therapy. Treatment with bromocriptine was stopped when pregnancy was diagnosed but 6 weeks later the prolactinoma 54.000 mui/l 6 semanas el tumor invasion of the las had regrownA las with suprasellar extension and lateral cavernous sinus. When treatment with bromocriptine was reinstituted symptoms subsided within 24 h and serum creció rápidamente prolactin concentrations fell from 54,000 mM/l to 2800 mU/l within 5 days and 500 mU/l 2 days after that. Pregnancy proceeded without complications and she enteredextendiéndose a regiones spontaneous labor at term and delivered a healthy baby. One year after delivery, on treatment with bromocriptine, her serum prolactin concentration remains supraselares within the normal range and the CT scan shows persistence of a small prolactinoma, confined to the pituitary fossa. Bromocriptine should be the primary treatment for prolactinomas regardless of tumor size and may be safely stopped when pregnancy is desired. If pituitary tumor complications occur during pregnancy, reintroduction of treatment with bromocriptine should again be the treatment of choice. PMID: 2880760 [PubMed - indexed for MEDLINE]
    • : Int J Gynaecol Obstet. 1986 Jun;24(3):209-15. Related Articles, Links El tumor regresó rápidamente y Rapid regression los niveles de prolactina descendieron through bromocriptine therapy of a suprasellar extending a 500 mUI/l a los 7 días prolactinoma during pregnancy. Se suspendió el tratamiento de reinstalado el tratamiento con con bromocriptina a una bromocriptina Tan SL, Jacobs HS. a. paciente de 29 cuando embarazó nivel de prolactina superó A 29-year-old woman is described who presented with amenorrhea and galactorrhea with a large prolactinoma El which regressed on bromocriptine therapy. Treatment with bromocriptine was stopped when pregnancy was diagnosed but 6 weeks later the prolactinoma 54.000 mui/l 6 semanas el tumor invasion of the las had regrownA las with suprasellar extension and lateral cavernous sinus. When treatment with bromocriptine was reinstituted symptoms subsided within 24 h and serum creció rápidamente prolactin concentrations fell from 54,000 mM/l to 2800 mU/l within 5 days and 500 mU/l 2 days after that. Pregnancy proceeded without complications and she enteredextendiéndose a regiones spontaneous labor at term and delivered a healthy baby. One year after delivery, on treatment with bromocriptine, her serum prolactin concentration remains supraselares within the normal range and the CT scan shows persistence of a small prolactinoma, confined to the pituitary fossa. Bromocriptine should be the primary treatment for prolactinomas regardless of tumor size and may be safely stopped when pregnancy is desired. If pituitary tumor complications occur during pregnancy, reintroduction of treatment with bromocriptine should again be the treatment of choice. PMID: 2880760 [PubMed - indexed for MEDLINE]
    • Fertil Steril. 1992 Sep;58(3):492-7. Related Articles, Links Macroprolactinomas with suprasellar extension: effect of bromocriptine withdrawal during one or more pregnancies. Ahmed M, al-Dossary E, Woodhouse NJ. Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia. OBJECTIVE: To investigate the effects of bromocriptine withdrawal during one or more pregnancies in patients who presented with pituitary macroprolactinomas with suprasellar extension. DESIGN: Four infertile patients presenting with a macroprolactinoma with suprasellar extension conceived during treatment with bromocriptine on 10 occasions resulting in eight full-term normal deliveries. Treatment was withheld shortly after conception in each pregnancy. RESULTS: Serum prolactin (PRL) levels fell initially from a mean of 2,776 (range 1,682 to 4,515) to 27 micrograms/L (range 1 to 71) with the development of a partially empty sella in all patients. Recovery of visual field defects occurred in the only affected individual. In case 1, PRL levels remained within the normal range, after bromocriptine withdrawal in the first pregnancy, with the development of an empty sella. Prolactin levels, however, increased substantially in cases 2 to 4. An asymptomatic suprasellar tumor extension returned in cases 2 and 3. After two or more pregnancies (cases 1, 3, and 4), there was a progressive decline in the serum PRL levels. Although still elevated in cases 3 and 4, the PRL levels were considerably below those obtained at presentation or in the first pregnancy. Tumor regression with the development of an empty sella was observed in both these patients as well in their pregnancy or postpartum period. CONCLUSIONS: Bromocriptine may be safely withdrawn during pregnancy in patients presenting with a macroprolactinoma. With multiple bromocriptine induced pregnancies, PRL levels and tumor size may progressively decrease with the eventual development of an empty sella. PMID: 1521641 [PubMed - indexed for MEDLINE]
    • Fertil Steril. 1992 Sep;58(3):492-7. Related Articles, Links Macroprolactinomas with suprasellar extension: effect of bromocriptine withdrawal during one or more pregnancies. Ahmed M, al-Dossary E, Woodhouse NJ. Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia. OBJECTIVE: To investigate the effects of bromocriptine withdrawal during one or more pregnancies in patients who presented with pituitary macroprolactinomas with suprasellar extension. DESIGN: Four infertile patients presenting with a macroprolactinoma with suprasellar extension conceivedlo largo de sucesivos A during treatment with bromocriptine on 10 occasions resulting in eight full-term normal deliveries. Treatment was withheld shortly after conception in each pregnancy. RESULTS: Serum prolactin (PRL) levels fell initially embarazos logrados con to from a mean of 2,776 (range 1,682 Bromocriptina, los niveles de 4,515) to 27 micrograms/L (range 1 to 71) with the development of a partially empty sella in all patients. Recovery of puede interrumpir elin the only affected individual. In case 1, PRL levels remained within Se visual field defects occurred the normal range, afterde los tumores PRL tienden a disminuir tratamiento bromocriptine withdrawal in the first pregnancy, with the development of an empty sella. Prolactin levels, however, increased substantially in cases 2 así comoel tamaño tumoral to 4. An asymptomatic suprasellar tumor hipofisarios con and 3. After two or more pregnancies (cases 1, 3, and 4), there was a extension returned in cases 2 extensión supraselar cuando se progressive decline in the serum PRL levels. Although still elevated in cases 3 and 4, the PRL levels were considerably below those obtained at presentation or in the first pregnancy. Tumor regression with the development lograemptyembarazo of an el sella was observed in both these patients as well in their pregnancy or postpartum period. CONCLUSIONS: Bromocriptine may be safely withdrawn during pregnancy in patients presenting with a macroprolactinoma. With multiple bromocriptine induced pregnancies, PRL levels and tumor size may progressively decrease with the eventual development of an empty sella. PMID: 1521641 [PubMed - indexed for MEDLINE]
    • Fertil Steril. 1992 Sep;58(3):492-7. Related Articles, Links Macroprolactinomas with suprasellar extension: effect of bromocriptine withdrawal during one or more pregnancies. Ahmed M, al-Dossary E, Woodhouse NJ. Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia. La reducción el algunos OBJECTIVE: To investigate the effects of bromocriptine withdrawal during one or more pregnancies in patients who presented with pituitary macroprolactinomas with suprasellar de casos alcanza el grado extension. DESIGN: Four infertile patients silla turca vacía presenting with a macroprolactinoma with suprasellar extension conceivedlo largo de sucesivos A during treatment with bromocriptine on 10 occasions resulting in eight full-term normal deliveries. Treatment was withheld shortly after conception in each pregnancy. RESULTS: Serum prolactin (PRL) levels fell initially embarazos logrados con to from a mean of 2,776 (range 1,682 Bromocriptina, los niveles de 4,515) to 27 micrograms/L (range 1 to 71) with the development of a partially empty sella in all patients. Recovery of puede interrumpir elin the only affected individual. In case 1, PRL levels remained within Se visual field defects occurred the normal range, afterde los tumores PRL tienden a disminuir tratamiento bromocriptine withdrawal in the first pregnancy, with the development of an empty sella. Prolactin levels, however, increased substantially in cases 2 así comoel tamaño tumoral to 4. An asymptomatic suprasellar tumor hipofisarios con and 3. After two or more pregnancies (cases 1, 3, and 4), there was a extension returned in cases 2 extensión supraselar cuando se progressive decline in the serum PRL levels. Although still elevated in cases 3 and 4, the PRL levels were considerably below those obtained at presentation or in the first pregnancy. Tumor regression with the development lograemptyembarazo of an el sella was observed in both these patients as well in their pregnancy or postpartum period. CONCLUSIONS: Bromocriptine may be safely withdrawn during pregnancy in patients presenting with a macroprolactinoma. With multiple bromocriptine induced pregnancies, PRL levels and tumor size may progressively decrease with the eventual development of an empty sella. PMID: 1521641 [PubMed - indexed for MEDLINE]