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Adénomes à prolactine et grossesse

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Pathologie hypophysaire et grossesse

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Ľhypophyse augmente de taille et la prolactinémie s’accroît progressivement pendant la grossesse normale. Les adénomes à prolactine (PRL) ne contre-indiquent quasiment jamais une grossesse mais imposent une surveillance variable selon que la patiente présente un mico-ou un macroprolactinome. Le risque ďévolution tumorale exposant à un trouble visuel durant la grossesse est inférieur à 5% en cas de microadénome à PRL, même si le traitement médical par agoniste dopaminergique est interrompu, permettant généralement de se contenter ďune surveillance assez simple sans traitement et ďautoriser un allaitement. Le risque de progression tumorale est supérieur en cas de macroprolactinome: avant de pouvoir proposer une éventuelle interruption des agonistes dopaminergiques, il faut donc avoir vérifié que le macroadénome, s’il augmente effectivement de taille pendant la grossesse, ne risquera pas de comprimer les voies optiques. Si ce risque est écarté, à condition de vérifier, par un champ visuel et une IRM réguliers pendant la grossesse, ľabsence ďaugmentation menaçante de ľadénome, il est possible ďinterrompre les agonistes dopaminergiques, quitte à les réintroduire si ľadénome augmente à nouveau de taille de façon préoccupante. En revanche, si ľadénome menace ďemblée le chiasma, il est préférable, soit de proposerune intervention chirurgicale de réduction tumorale avant la grossesse, soit, de préférence, demaintenir, tout au long de la grossesse, le traitement par agoniste dopaminergique (en préférant la bromocriptine pour laquelle on dispose de plus de données sur ľabsence ďeffets tératogènes). Les données maintenant rassurantes de pharmacovigilance, quant aux risques fœtaux des agonistes dopaminergiques, permettent ďenvisager de façon plus sereine leur utilisation pendant la grossesse si celle-ci s’avère nécessaire.

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Authors
  1. Ph. Chanson
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  2. B. Delemer
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Chanson, P., Delemer, B. (2007). Adénomes à prolactine et grossesse. In: Pathologie hypophysaire et grossesse. Springer, Paris. https://doi.org/10.1007/978-2-287-35572-1_5

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  • DOI: https://doi.org/10.1007/978-2-287-35572-1_5

  • Publisher Name: Springer, Paris

  • Print ISBN: 978-2-287-35571-4

  • Online ISBN: 978-2-287-35572-1

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