Management of Prolactinoma during Pregnancy by Physicians from the Middle East and North Africa: A Case-Based Survey

Abstract

Abstract The guidelines for managing prolactinomas during pregnancy are primarily based on retrospective evidence or expert opinion. A case-based questionnaire was sent to a convenience sample of endocrinologists (N = 116) and internists (N = 13) in the Middle East (N = 147) and North Africa (N = 33). Three cases of varying severity were presented, ranging from microprolactinoma to large macroprolactinoma compressing the optic chiasm. In the case of microprolactinoma, 86.7% of respondents would discontinue dopamine agonist (DA) medications when pregnancy is confirmed, 66.1% would discontinue serum prolactin measurement during pregnancy, and 95.4% would not request pituitary imaging routinely if no new symptoms developed. In contrast, only 20.0% would perform regular formal visual field (VF) testing throughout pregnancy. In the case of macroprolactinoma with no VF defect, 38.9% chose to discontinue DA therapy upon confirmation of pregnancy, 20.0% would either perform regular magnetic resonance imaging (MRI) during pregnancy or if serum prolactin were thought to be elevated out of proportion by clinical judgment, and 36.7% would not perform regular formal VF monitoring during pregnancy. In the management of macroprolactinoma with VF defect, 61.1% elected to continue DA therapy, whereas 33.9% considered referral for surgical excision as the treatment of choice. Note that 42.8% would perform regular MRIs during pregnancy, and 90.0% would perform regular formal VF monitoring. A survey of physicians revealed a diversity in managing prolactinomas during pregnancy, better education and regional adoption of the guidelines.