Physiological Changes in Pregnancy
Prolactinoma in pregnancy, all are true except (AIIMS May 2011)
|A||Most common pituitary tumor but rarely symptomatic|
|B||Increase in prolactin levels worse prognosis|
|C||Macroadenoma >1 cm increased in size rapidly|
|D||Regular visual checkup|
Increase in prolactin levels worse prognosis
a. The very high levels of circulating estrogen that occur during pregnancy result in a parallel increase in the circulating levels of prolactin. The prolactin increase prepares the breasts for lactation. Prolactin levels begin to
b. Rise at 5-8 weeks into the gestation period and parallel the increase in the size and number of lactotrophs. At the end of the first trimester, serum prolactin levels are approximately 20-40 ng/mL. They increase further to 50-150 ng/mL and are 100-400 ng/mL at the end of the second and third trimesters, respectively. This is likely mediated by a direct effect on the lactotroph. A combination of factors may be responsible. Prolactin responses to normal stimuli (eg, sleep, meals, suckling) are maintained throughout pregnancy.
c. A woman with macroprolactinemia (biologically inactive large molecule) produces normal amounts of biologically active prolactin during pregnancy and lactation.
d. Given the stimulatory effects of pregnancy on the normal lactotrophs, enlargement of the normal pituitary can be expecteD. This does not necessarily mean that the adenomatous pituitary may enlarge. Prolactinomas that symptomatically enlarge during pregnancy are uncommon. Symptoms suggestive of growth are headache, visual field changes, and diabetes insipidus.
e. Women with prolactin-secreting tumors may experience further pituitary enlargement and must be closely monitored during pregnancy. However, damage to the pituitary or eye nerves occurs in less than 1 percent of pregnant women with prolactinomA. In women with larger tumors, the risk of damage to the pituitary or eye nerves is greater, and some doctors consider it as high as 25 percent. If a woman has completed a successful pregnancy, the chances of her completing additional successful pregnancies are extremely high.
f. A woman with a prolactinoma should discuss her plans to conceive with her physician so that she can be carefully evaluated prior to becoming pregnant. This evaluation will likely include a magnetic resonance imaging (MRI) scan to assess the size of the tumor and an eye examination with a test of the visual fields.