by Anne Eglash MD, IBCLC, FABM
How do prolactinomas impact breastfeeding? A prolactinoma is a non-cancerous tumor of the pituitary gland which secretes excessive prolactin. Common symptoms are irregular menses, nipple discharge, headaches, and difficulty becoming pregnant. According to a recent summary entitled ‘Prolactinoma through the Female Life Cycle‘ they are the most common cause of a high prolactin level, possibly occurring in 27% of people, although many people will never have symptoms. They are most frequently found in women between the ages of 20-50.
Women with prolactinomas are often treated with medications such as cabergoline, which increase dopamine, because increasing dopamine decreases prolactin secretion from the pituitary gland. Many women are able to become pregnant once the prolactin level has been brought down to a normal range.
During pregnancy, most prolactinomas remain clinically stable and do not grow significantly, especially if they were treated with a dopamine agonist, radiation, or surgery before becoming pregnant.
What do you think are true statements regarding prolactinomas and breastfeeding, according to the authors of this review? (choose 1 or more)
- In healthy breastfeeding women without a prolactinoma, prolactin levels are lower postpartum than they are during pregnancy.
- Women who underwent a surgical resection of a prolactinoma before pregnancy have a 30% chance of adequate lactation.
- There are no absolute contraindications to breastfeeding as long as there is not symptomatic tumor enlargement during pregnancy.
- Breastfeeding women with a prolactinoma can take a dopamine agonist such as cabergoline and still be successful breastfeeding.
- Pregnancy may act as a treatment for pituitary adenomas, because up to 70% of women show remission of their prolactinoma postpartum, whether breastfeeding or not.
- Women who undergo dopamine agonist treatment (ie cabergoline) for 2 years have a 24-69% risk of recurrence after medication withdrawal.
See the Answer
All are correct except D
Prolactinoma through the female life cycle
Cocks Eschler D, Javanmard P, Cox K, Geer EB.
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.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
Prolactinomas are very common in women, and anyone who works with breastfeeding women will come across women who have questions about their history of prolactinoma, and how the prolactinoma will affect lactation. According to this article, 70% of women who had surgical treatment of the prolactinoma before pregnancy will have problems breastfeeding. It does not appear that we know the impact of dopamine agonist treatment pre-pregnancy on lactation outcomes postpartum.
From my experience, women with a history of prolactinomas have varied lactation outcomes. Some women have hyperlactation, some have a normal supply, and some have insufficient lactation. Perhaps it is the treatment pre-pregnancy that impacts the prolactin level postpartum.
Women who take cabergoline during lactation will not be able to continue lactation. Cabergoline causes a marked drop in prolactin, such that the milk supply drops precipitously, no matter how far along the mother is postpartum.
The good news from this article is that women with prolactinomas should not be prevented from breastfeeding. If they experience symptoms of pituitary tumor growth during pregnancy such as headaches or change in vision, endocrinology should be consulted on management of the tumor postpartum. And finally, pregnancy might be just what the doctor ordered, since a large % of prolactinomas resolve with pregnancy and the postpartum period.