If a woman with a prolactin secreting tumor becomes pregnant while undergoing medical treatment should the treatment be interrupted? Should she breastfeed her infant?
Even though many studies have found that maternal treatment with dopamine agonists is safe for the fetus, it is recommended that the drug be stopped as soon as pregnancy is diagnosed. The risk of tumor reexpansion is low, < 5% for small prolactin-secreting tumors and 15% to 35% for large tumors. Assessment of symptoms, particularly headaches, and visual field tests should be performed every 1 to 3 months; any evidence of tumor reexpansion should prompt the reinstitution of treatment. Breastfeeding does not appear to add any significant risk for these patients, but close follow-up should be continued. Once breastfeeding ends, the prolactin level should be measured 2 to 3 months later and treatment with a dopamine agonist should be restarted if the prolactin level is high.