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Management of prolactinoma in pregnancy is a big challenge for the treating obstetrician as prolactin levels are normally raised in pregnancy and this creates a possibility of missing the diagnosis of prolactinoma. Women with micro adenomas and intrasellar macro adenomas do not require serial magnetic resonance imaging (MRI) or visual field testing...
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Objective
The objective of this study was to describe and characterize the clinical course of treatment for invasive prolactinoma patients using bromocriptine.
Methods
The study group included 23 patients who were treated with bromocriptine for their invasive prolactinomas. Clinical histories, serum prolactin level and pituitary hormone assessment...
Citations
... In this case, the patient's β-hCG was not examined, considering that the patient's gestational age was 31-32 weeks. Physiologically serum β-hCG increases at 9-10 weeks of gestation, however, after these weeks, the levels begin to decrease, and the production of HPL (human placenta lactogen) will start to increase, especially at 20 weeks of gestation until the end of pregnancy [10]. On this basis, the serum β-hCG in this patient was not examined considering the normal physiology of pregnancy, where results cannot be interpreted. ...
Introduction: Incidence of ectopic pregnancy can be an acute or chronic condition. The condition of chronic ectopic pregnancy itself is unique, arises from a minor rupture, and then develops into a hematocele. Chronic ectopic pregnancy is quite complicated to diagnose because it usually has a prolonged clinical course and can disappear spontaneously. Case Presentation: A woman aged 31-32 weeks, aged 24 years, complained of right abdominal pain accompanied by nausea and vomiting. Examination of vital signs was 120/80 mmHg, pulse 84 x/min, RR 20x/min, temperature 36.70C, and SpO2 of 98% with pale conjunctiva and abdominal tenderness in the right upper quadrant. On laboratory examination, the patient found severe microcytic normochromic anemia (Hb 4.5 mg/dl; MCV 96.6 Fl; MCH 30.2 pg), thrombocytopenia (platelets 133,000 L) and hypoalbumin (albumin 2.82 L). Ultrasound examination showed a mass in the right adnexa accompanied by intrauterine pregnancy. The patient underwent a laparotomy and found a mass in the form of a blood clot (hematocele) of 30x20x20 cm. Conclusion: Chronic ectopic pregnancy is a rare condition, especially in developed countries. A clinician should be more detailed in diagnosing and considering the ultrasound, an amorphous mass with avascularity to amass with complex vascular formation. This is very necessary considering that this hematocele mass can develop progressively to cause fetal growth disorders.
... Cabergoline, category B according to FDA [4], is the alternative DA, because it has a good safety profile without teratogenic effect; although it is not recommended for prolactinoma pharmacotherapy in pregnancy because long-term use (over 1 year) has been associated with fibrosis of the heart valves and constant supervision by echocardiography is necessary [114]. ...
https://www.mdpi.com/1660-4601/16/5/781
Pregnancy in women with associated endocrine conditions is a therapeutic challenge for clinicians. These disorders may be common, such us thyroid disorders and diabetes, or rare, including adrenal and parathyroid disease and pituitary dysfunction. With the development of assisted reproductive techniques, the number of pregnancies with these conditions has increased. It is necessary to recognize symptoms and correct diagnosis for a proper pharmacotherapeutic management in order to avoid adverse side effects both in mother and fetus. This review summarizes the pharmacotherapy of these clinical situations in order to reduce maternal and fetal morbidity.
... 13,14 However, human studies have demonstrated the association of CAB with risk factors such as spontaneous miscarriages, stillbirths, pre-term deliveries, congenital malformations and neonatal abnormalities. 15 Rains et al., based on a review, have reported the occurrence of ten congenital abnormalities among 199 human cases of CABassociated pregnancy. 1 Although certain studies have raised concern over the use of CAB as the first choice of drug in the treatment of prolactinoma-associated pregnancies, recent evidence suggests that the drug can be considered as the first choice in pregnant women. ...
... 1 Although certain studies have raised concern over the use of CAB as the first choice of drug in the treatment of prolactinoma-associated pregnancies, recent evidence suggests that the drug can be considered as the first choice in pregnant women. Bajwa et al. (2011) have suggested that prolactinoma can be successfully treated with CAB during pregnancy without any adverse effects. 15 An observational, retrospective, multicenter study, involving 103 cases of pregnancy in 90 females undergoing CAB treatment, by Stalldecker et al. (2010) has reported that drug-related complications in pregnancy and in offspring exposed to CAB were comparable in patients undergoing treatment and normal population. ...
... Bajwa et al. (2011) have suggested that prolactinoma can be successfully treated with CAB during pregnancy without any adverse effects. 15 An observational, retrospective, multicenter study, involving 103 cases of pregnancy in 90 females undergoing CAB treatment, by Stalldecker et al. (2010) has reported that drug-related complications in pregnancy and in offspring exposed to CAB were comparable in patients undergoing treatment and normal population. 16 A long-term observational study by Colao et al. (2008), involving 380 cases of pregnancy, has shown that foetal exposure to CAB, during early period of gestation, does not increase the risk of miscarriage or foetal malformations. ...
... Lactotroph cells, normally occupying about 1/5 of the pituitary, account for ½ of pituitary cells by the end of pregnancy. Similarly, PRL levels may increase to over 100-400 ng/mL by the end of a normal pregnancy [68]. ...
Prolactinomas are the most common secretory pituitary adenoma. They typically occur in women in the 3rd–6th decade of life and rarely in the pediatric population or after menopause. Most women present with irregular menses and/or infertility. Dopamine (DA) agonists, used in their treatment, are safe during pregnancy, but in most cases are discontinued at conception with close monitoring for signs or symptoms of tumor growth. Breastfeeding is safe postpartum, provided there was no significant growth during pregnancy. Some women will experience normalization of prolactin levels postpartum. Menopause may also decrease prolactin levels and even those with macroprolactinomas may consider discontinuing their DA agonist with close follow-up. Prolactinomas may be associated with decreased quality of life scores in women, and play a role in bone health and cardiovascular risk factors. This review discusses the current literature and clinical understanding of prolactinomas throughout the entirety of the female life cycle.
... These tumors can also complicate the pregnancy as well as anesthesia procedure for any surgery during pregnancy. [10,11] These are benign tumors, commonly located in sellar or suprasellar regions and constitute about 2-6% of all primary intracranial tumors in childhood. Patients with these tumors can have both pressure symptoms and endocrine derangements in the form of deficiency of growth hormone, gonadotropin, thyroid stimulating hormone and adreno-corticotrophic hormone. ...
The gateways to advancements in medical fields have always been accessed through the coalition between various specialties. It is almost impossible for any specialty to make rapid strides of its own. However, the understanding of deeper perspectives of each specialty or super specialty is essential to take initiatives for the progress of the other specialty. Endocrinology and anesthesiology are two such examples which have made rapid progress in the last three decades. Somehow the interaction and relationship among these medical streams have been only scarcely studied. Diabetes and thyroid pathophysiologies have been the most researched endocrine disorders so far in anesthesia practice but even their management strategies have undergone significant metamorphosis over the last three decades. As such, anesthesia practice has been influenced vastly by these advancements in endocrinology. However, a comprehensive understanding of the relationship between these two partially related specialties is considered to be an essential cornerstone for further progress in anesthesia and surgical sciences. The current review is an attempt to imbibe the current and the changing perspectives so as to make the understanding of the relationship between these two medical streams a little simple and clearer.
... These tumors can also complicate the pregnancy as well as anesthesia procedure for any surgery during pregnancy. [10,11] These are benign tumors, commonly located in sellar or suprasellar regions and constitute about 2-6% of all primary intracranial tumors in childhood. Patients with these tumors can have both pressure symptoms and endocrine derangements in the form of deficiency of growth hormone, gonadotropin, thyroid stimulating hormone and adreno-corticotrophic hormone. ...
... [36] Presence of thyroid pathology, pituitary disease, adrenal insufficiency and other endocrine disorders mandates as much emergency optimization as possible before any emergency orthopedic surgery. [38][39][40][41][42] Decisive role of nutritional status Malnutrition is usually prevalent in 30-50% of elderly patients but nutritional status of elderly is generally overlooked during pre-anesthetic assessment and optimization. [42][43][44][45][46] Nutritional deficiencies may be the precipitating risk factors of various peri-operative complications including respiratory failure, pharmacokinetic and pharmacodynamic alterations, infections and impaired wound healing, prolonged intubation, poor recovery and higher morbidity and mortality. ...
... [38][39][40][41][42] Decisive role of nutritional status Malnutrition is usually prevalent in 30-50% of elderly patients but nutritional status of elderly is generally overlooked during pre-anesthetic assessment and optimization. [42][43][44][45][46] Nutritional deficiencies may be the precipitating risk factors of various peri-operative complications including respiratory failure, pharmacokinetic and pharmacodynamic alterations, infections and impaired wound healing, prolonged intubation, poor recovery and higher morbidity and mortality. [43][44][45][46][47] Pre-operative nutritional assessment in elderly should be done fairly to improve surgical outcome. ...
Despite so many advancements and innovations in anesthetic techniques, expectations and challenges have also grown in plenty. Cardiac, pediatric, obstetric and neuro-anesthesia have perfectly developed to fulfill the desired needs of respective patient population. However, geriatric anesthesia has been shown a lesser interest in teaching and clinical practices over the years as compared with other anesthetic sub-specialties. The large growing geriatric population globally is also associated with an increase number of elderly patients presenting for orthopedic emergency surgeries. Orthopedic emergency surgery in geriatric population is not only a daunting clinical challenge but also has numerous socio-behavioral and economic ramifications. Decision making in anesthesia is largely influenced by the presence of co-morbidities, neuro-cognitive functions and the current socio-behavioral status. Pre-anesthetic evaluation and optimization are extremely important for a better surgical outcome but is limited by time constraints during emergency surgery. The current review aims to highlight comprehensively the various clinical, social, behavioral and psychological aspects during pre-anesthetic evaluation associated with emergency orthopedic surgery in geriatric population.
... Thus, close clinical monitoring, especially within the first year after withdrawal, should be carried out in all patients in whom CAB therapy is discontinued. According to previous studies, predictor factors for higher chance of successful CAB withdrawn include lower PRL levels, longer duration of treatment, tumor size (micro-> macroadenomas), previous pituitary radiotherapy or surgery, and pregnancy (5,12,13,15,16,22). It has been shown that women with prolactinomas who became pregnant have a higher rate of remission than women without previous pregnancy (22,23). ...
... According to previous studies, predictor factors for higher chance of successful CAB withdrawn include lower PRL levels, longer duration of treatment, tumor size (micro-> macroadenomas), previous pituitary radiotherapy or surgery, and pregnancy (5,12,13,15,16,22). It has been shown that women with prolactinomas who became pregnant have a higher rate of remission than women without previous pregnancy (22,23). Moreover, PRL levels are lower after delivery as compared to levels before conception and complete remission of hyperprolactinemia has been reported in 17-37% of women after pregnancy (23). ...
Successful discontinuation of cabergoline (CAB) treatment has been reported in 31–75% of prolactinomas patients treated for at least 2 years. In contrast, it is not well established whether CAB therapy can be successfully withdrawn after a failed first attempt. This prospective open trial was designed to address this topic and to try to identify possible predictor factors. Among 180 patients with prolactinomas on CAB therapy, the authors selected those who fulfilled very strict criteria, particularly additional CAB therapy for at least 2 years, normalization of serum prolactin (PRL) levels following CAB restart, no tumor remnant >10 mm, no previous pituitary radiotherapy or surgery; and current CAB dose ≤1.0 mg/week. Recurrence was defined as an increase of PRL levels above the upper limit of normal. A total of 34 patients (70.6% female) treated with CAB for 24–30 months were recruited. Ten patients (29.4%) remained without evidence of recurrence after 24–26 months of follow-up. Twenty-four patients (70.6%) recurred within 15 months (75% within 12 months) after drug withdrawal and ~80% were restarted CAB. Median time to recurrence was 10.5 months (range, 3–15). Despite overlapping values, non-recurring patients had significantly lower mean PRL levels before withdrawal. Moreover, the recurrence rate was lower in subjects without visible tumor on pituitary magnetic resonance imaging (MRI) than in those with small remnant tumor (60 vs. 79%), though the difference was not statistically significant (P = 0.20). No other characteristic could be identified as a predictor of successful CAB discontinuation. In conclusion, a second attempt of CAB withdrawal after two additional years of therapy may be successful, particularly in patients with lower PRL levels and no visible tumor on pituitary MRI. Close monitoring of PRL level is mandatory, especially within the first year after withdrawal, where most recurrences are detected.
... The diseases, both specific and non-specific to pregnancy, affects equally in terms of increasing the morbidity and mortality in obstetric patients. [71][72][73][74] The respiratory diseases such as acute exacerbation of asthma, pneumonitis, pulmonary edema, acute respiratory distress syndrome and acute lung injury can have serious implications both for the mother and the fetus and special considerations during these episodes include maintaining oxygen saturation greater than 90%. [75] Cardiovascular diseases, such as RHD, mitral stenosis and other valvular lesions can cause cardiac failure, which necessitates intensive care admission. ...
The presence of co-morbidities during pregnancy can pose numerous challenges to the attending anesthesiologists during operative deliveries or during the provision of labor analgesia services. The presence of cardiac diseases, endocrinological disorders, respiratory diseases, renal pathologies, hepatic dysfunction, anemia, neurological and musculoskeletal disorders, connective tissue diseases and many others not only influence the obstetric outcome, but can significantly impact the anesthetic technique. The choice of anesthesia during the pregnancy depends upon the type of surgery, the period of gestation, the site of surgery, general condition of patient and so on. Whatever, the anesthetic technique is chosen the methodology should be based on evidentially supported literature and the clinical judgment of the attending anesthesiologist. The list of co-morbid diseases is unending. However, the present review describes the common co-morbidities encountered during pregnancy and their anesthetic management during operative deliveries.
... Endocrine emergencies are very difficult to diagnose and treat especially if the patients have co-morbid diseases such diabetes, hypertension, morbid obesity, AIDS, cardiac diseases and so on [26][27][28][29]. Patients with certain endocrine tumour pathologies of brain may require special treatment during pregnancy as these patients have excellent prognosis [30]. ...
