Abstract
Hyperprolactinemia, frequently caused by a prolactinoma, is an important cause of infertility among young women. Dopamine agonists (DA) are the treatment of choice. Although cabergoline (CAB) is currently considered the gold standard DA, bromocriptine (BRC) remains the drug of choice for women desiring pregnancy, as it was proven to be safe in more than 6,000 pregnancies. The purpose of this review is to perform a critical evaluation of CAB safety in pregnancy, as it is used by most patients harboring prolactinomas. Although the number of CAB-induced pregnancies (about 800) is still reduced as compared with those under BRC treatment, data in the literature do not point to increase risk of preterm delivery or fetal malformations, comparing to pregnancies induced by BRC and those in the general population. Moreover, CAB use throughout pregnancy was reported in about ten cases, without evidence of any harm to fetal development. Therefore, even though BRC still remains the recommended DA drug for pregnancy induction or use during pregnancy in women with prolactinomas, increasing evidences point to the safety of CAB for this purpose.
Similar content being viewed by others
References
A. Glezer, M.D. Bronstein, Approach to the patient with persistent hyperprolactinemia and negative sellar imaging. J. Clin. Endocrinol. Metab. 97(7), 2211–2216 (2012)
F.F. Casanueva, M.E. Molitch, J.A. Schlechte, R. Abs, V. Bonert, M.D. Bronstein, T. Brue, P. Cappabianca, A. Colao, R. Fahlbusch, H. Fideleff, M. Hadani, P. Kelly, D. Kleinberg, E. Laws, J. Marek, M. Scanlon, L.G. Sobrinho, J.A. Wass, A. Giustina, Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clin. Endocrinol. (Oxf) 65(2), 265–273 (2006)
T. Mancini, F. Casanueva, A. Giustina, Hyperprolactinemia and prolactinomas. Endocrinol. Metab. Clin. North Am. 2008(37), 67–99 (2008)
S. Melmed, F.F. Casanueva, A.R. Hoffman, D.L. Kleinberg, V.M. Montori, J.A. Schlechte, J.A. Wass, Endocrine Society, Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 96(2), 273–288 (2011)
C. Sonigo, J. Bouilly, N. Carré, V. Tolle, A. Caraty, J. Tello, F.J. Simony-Conesa, R. Millar, J. Young, N. Binart, Hyperprolactinemia-induced ovarian acyclicity is reversed by kisspeptin administration. J. Clin. Invest. 22(10), 3791–3795 (2012)
R. Araujo-Lopes, J.R. Crampton, N.S. Aquino, R.M. Miranda, I.C. Kokay, A.M. Reis, C.R. Franci, D.R. Grattan, R.E. Szawka, Prolactin regulates kisspeptin neurons in the arcuate nucleus to suppress LH secretion in female rats. Endocrinology 155(3), 1010–1020 (2014)
R. Salvatori, Surgical treatment of microprolactinomas: pros. Endocrine (2014). doi:10.1007/s12020-014-0281-3
T.H. Jones, R.B. Fraser, Cabergoline-treated hyperprolactinemia results in pregnancy in a bromocriptine-intolerant patient after seventeen years of infertility. Br. J. Obstet. Gynaecol. 101, 349–350 (1994)
G. Tamburrano, M.L. Jafrain-Rea, C. Bulleta et al., Cabergoline and bromocriptine-induced pregnancies in women with non-operated microprolactinomas. J. Endocrinol. Invest. 14(Suppl 1), 104 (1994)
D. Beltrame, M. Longo, G. Mazue, Reproductive toxicity of cabergoline in mice, rats, and rabbits. Reprod.Toxicol. 10, 471–483 (1996)
J. Webster, G. Piscitelli, A. Polli, C.I. Ferrari, I. Ismail, M.F. Scanlon, A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea Cabergoline. Comparative Study Group. New Engl. J. Med. 331, 942–944 (1994)
E. Robert, L. Musatti, G. Piscitelli, C.I. Ferrari, Pregnancy outcome after treatment with the ergot derivative, cabergoline. Reprod. Toxicol. 10, 333–337 (1996)
J. Verhelst, R. Abs, D. Maiter et al., Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients. J. Clin. Endocrinol. Metab. 84, 2518–2522 (1999)
M.D. Bronstein, Prolactinomas and pregnancy. Pituitary 8, 31–80 (2005)
E. Ricci, F. Parazzini, T. Motta, C.I. Ferrari, A. Colao, A. Clavenna, F. Rocchi, E. Gangi, S. Paracchi, M. Gasperi, M. Lavezzari, A.E. Nicolosi, S. Ferrero, M.L. Landi, P. Beck-Peccoz, M. Bonati, Pregnancy outcome after cabergoline treatment in early weeks of gestation. Reprod. Toxicol. 16, 791–793 (2002)
M. Laloi-Michelin, N. Ciraru-Vigneron, T. Meas, Cabergoline treatment of pregnant women with macroprolactinomas. Int. J. Gynaecol. Obstet. 99(1), 61–62 (2007)
A. Colao, R. Abs, D.G. Bárcena, P. Chanson, W. Paulus, D.L. Kleinberg, Pregnancy outcomes following cabergoline treatment: extended results from a 12-year observational study. Clin. Endocrinol. 68(1), 66–71 (2008)
M. Lebbe, C. Hubinont, P. Bernard, D. Maiter, Outcome of 100 pregnancies initiated under treatment with cabergoline in hyperprolactinaemic women. Clin. Endocrinol. (Oxf) 73(2), 236–242 (2010)
M. Ono, N. Miki, K. Amano, T. Kawamata, T. Seki, R. Makino, K. Takano, S. Izumi, Y. Okada, T. Hori, Individualized high-dose cabergoline therapy for hyperprolactinemic infertility in women with micro- and macroprolactinomas. J. Clin. Endocrinol. Metab. 95(6), 2672–2679 (2010)
G. Stalldecker, M.S. Mallea-Gil, M. Guitelman, A. Alfieri, M.C. Ballarino, L. Boero, A. Chervin, K. Danilowicz, S. Diez, P. Fainstein-Day, N. García-Basavilbaso, M. Glerean, V. Gollan, D. Katz, M.G. Loto, M. Manavela, A.S. Rogozinski, M. Servidio, N.M. Vitale, Effects of cabergoline on pregnancy and embryo-fetal development: retrospective study on 103 pregnancies and a review of the literature. Pituitary 13(4), 345–350 (2010)
R.S. Auriemma, Y. Perone, A. Di Sarno, L.F. Grasso, E. Guerra, M. Gasperi, R. Pivonello, A. Colao, Results of a single-center observational 10-year survey study on recurrence of hyperprolactinemia after pregnancy and lactation. J. Clin. Endocrinol. Metab. 98(1), 372–379 (2013)
P. Krupp, C. Monka, K. Richter, The safety aspects of infertility treatments (Program of the Second Word Congress of Gynecology and Obstetrics, Rio de Janeiro, 1988)
I. Chiodini, A. Liuzzi, PRL-secreting adenomas in pregnancy. J Endocrinol. Invest. 26, 96–99 (2003)
J. Jones, T. Bashir, J. Olney, T. Wheatley, Cabergoline treatment for a large macroprolactinoma throughout pregnancy. J. Obstet. Gynaecol. 17(4), 375–376 (1997)
C. Liu, J.B. Tyrrell, Successful treatment of a large macro-prolactinoma with cabergoline during pregnancy. Pituitary 4, 179–185 (2001)
G. Forsbach-Sánchez, H.E. Tamez-Pérez, R. Hernández-Herrera, B. Bafidis-Lechuga, Treatment of macroprolactinoma with cabergoline during pregnancy. Rev. Med. Inst. Mex. Seguro Soc. 47(3), 307–310 (2009)
A. Banerjee, K. Wynne, T. Tan, E.C. Hatfield, N.M. Martin, C. Williamson, K. Meeran, High dose cabergoline therapy for a resistant macroprolactinoma during pregnancy. Clin. Endocrinol. (Oxf) 70(5), 812–813 (2009)
S.K. Bajwa, S.J. Bajwa, P. Mohan, A. Singh, Management of prolactinoma with cabergoline treatment in a pregnant woman during her entire pregnancy. Indian J. Endocrinol. Metab. 15(Suppl 3), S267–S270 (2011)
H. Shahzad, A. Sheikh, L. Sheikh, Cabergoline therapy for macroprolactinoma during pregnancy: a case report. BMC Res Notes 5, 606 (2012)
M.E. Molitch, Prolactinoma in pregnancy. Best Pract. Res. Clin. Endocrinol. Metab. 25(6), 885–896 (2011)
E. Sundström, S. Kölare, F. Souverbie et al., Neurochemical differentiation of human bulbospinal monoaminergic neurons during the first trimester. Brain Res. Dev. Brain Res. 75(1), 1–12 (1993)
E. Herlenius, H. Lagercrantz, Development of neurotransmitter systems during critical periods. Exp. Neurol. 190(Suppl 1), S8–S21 (2004)
E. Del Pozo, P. Krupp, Endocrine effects of dopamine receptor stimulation on the fetal-maternal unit (Drugs and pregnancy academic press, London, 1984), pp. 191–201
C. Hurault-Delarue, J.-L. Montastruc, A.-B. Beau, I. Lacroix, C. Damase-Michel, Pregnancy outcome in women exposed to dopamine agonists during pregnancy: a pharmacoepidemiology study in EFEMERIS database. Arch. Gynecol. Obstet. 23(6), 586–594 (2014)
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Glezer, A., Bronstein, M.D. Prolactinomas, cabergoline, and pregnancy. Endocrine 47, 64–69 (2014). https://doi.org/10.1007/s12020-014-0334-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12020-014-0334-7