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Revista de la Facultad de Ciencias Médicas de Córdoba
Article . 2015 . Peer-reviewed
License: CC BY NC
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Prolactinoma y embarazo

Authors: Paula Estario; Laura Anahi Cecenarro; María Eugenia Estario; Carolina Fux Otta;
Abstract

RESUMEN Los prolactinomas son los tumores hipofisarios funcionantes más comunes. La hiperprolactinemia que generan se asocia con anovulación e infertilidad. OBJETIVOS: a) describir la relación entre hiperprolactinemia y fertilidad, b) revisar los resultados del uso de agonistas dopaminérgicos durante el embarazo y el desarrollo embriofetal y c) actualizar el manejo terapéutico en micro y macroprolactinomas durante la gestación. CONTENIDO: Los agonistas dopaminérgicos son el tratamiento de primera línea para prolactinomas de cualquier tamaño o grado de invasión y restauran los ciclos ovulatorios en el 80 a 90 % de las pacientes. La cabergolina se sugiere actualmente en lugar de bromocriptina, debido a su excelente tolerabilidad y prolongada vida media. Se aconseja que la exposición fetal a todos los medicamentos sea lo más limitada posible. Ante la ausencia del período menstrual debe suspenderse el fármaco y confirmar el embarazo. CONCLUSION: Tanto bromocriptina como cabergolina no mostraron evidencia de complicaciones obstétricas ni neonatales, sin embargo, la experiencia con bromocriptina es mayor. Las pacientes con macroprolactinomas deben ser controladas clínicamente y evaluar sintomatología relacionada con el aumento del tamaño tumoral. Si se sospecha crecimiento del adenoma, debe solicitarse resonancia magnética nuclear y examen neuro-oftalmológico. En microprolactinomas la campimetría no es una indicación formal. Hay evidencia de que la lactancia materna no presenta mayor riesgo para el crecimiento tumoral. ABSTRACT The prolactinomas are the most common functioning pituitary tumors. The hyperprolactinemia is associated with anovulation and infertility. OBJECTIVES: a) describe the relationship between hyperprolactinemia and fertility, b) review the results of the use of dopamine agonists during pregnancy and embryo-fetal development and c) review the therapeutic management in micro and macroprolactinomas during pregnancy. CONTENT: Medical therapy with dopamine agonists is the best treatment for prolactinomas of any size or invasiveness and restores ovulatory cycles in 80-90 % of patients. Cabergoline currently suggested rather than bromocriptine due to their excellent tolerability and long half-life. In general, it is recommended that fetal exposure to all drugs be limited to as short a period as possible. In the absence of menstrual period, the drug should be discontinued and confirm pregnancy. CONCLUSION: Both, bromocriptine and cabergoline, showed no evidence of obstetric and neonatal complications; however, experience with bromocriptine is higher. The patients with macroprolactinomas should be monitored clinically and evaluate the symptoms related to increased tumor size. If growth in the adenoma is suspected, nuclear magnetic resonance and neuro-ophthalmologic examination should be performed. In microprolactinomas the ophthalmologic examination is no formal indication. There is evidence that breastfeeding no increased risk for tumor growth. 

Keywords

Medicine (General), R5-920, Embarazo, R, Agonista dopaminérgicos, Medicine, Prolactinoma

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citations
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
0
Average
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