Molitch M E
Center for Endocrinology, Metabolism and Molecular Medicine, Northwestern University Medical School, Chicago, IL 60611, USA.
J Reprod Med. 1999 Dec;44(12 Suppl):1121-6.
Infertility is a common problem for women presenting with hyperprolactinemia, and lowering of prolactin (PRL) levels to normal or near normal is often necessary to permit ovulation. Dopamine agonists are effective in a majority of women, with cabergoline somewhat more effective than bromocriptine. Bromocriptine use by the mother appears to be safe for the developing fetus when its use is discontinued four to six weeks after conception. For women with microadenomas, the subsequent risk of adenoma growth during pregnancy appears to be 1% after discontinuing the drug, and symptomatic follow-up each trimester appears to be reasonable in such patients. For women with macroadenomas, bromocriptine may be discontinued after diagnosis of pregnancy (23% risk of tumor enlargement) or continued throughout pregnancy with monthly visual field testing. Alternatively, prepregnancy debulking of the tumor may be undertaken with appropriate follow-up (2.8% risk of tumor enlargement). Although data are less extensive on cabergoline, preliminary evidence does not suggest any increase in adverse fetal outcomes. As such, therapeutic abortion is not warranted if pregnancy occurs during cabergoline treatment. The drug appears reasonably safe for continued use. Further accrual of safety data will clarify that issue.
不孕症是高催乳素血症女性的常见问题，通常需要将催乳素（PRL）水平降至正常或接近正常才能排卵。多巴胺激动剂对大多数女性有效，卡麦角林比溴隐亭稍有效。如果母亲在受孕后四至六周停药，使用溴隐亭对发育中的胎儿似乎是安全的。对于患有微腺瘤的女性，停药后怀孕期间腺瘤生长的后续风险似乎为1%，在此类患者中每三个月进行症状随访似乎是合理的。对于患有大腺瘤的女性，可在确诊怀孕后停用溴隐亭（肿瘤增大风险为23%）或在整个孕期持续使用并每月进行视野检查。或者，可在怀孕前对肿瘤进行减容并进行适当随访（肿瘤增大风险为2.8%）。虽然关于卡麦角林的数据较少，但初步证据并未表明胎儿不良结局会增加。因此，如果在卡麦角林治疗期间怀孕，不建议进行治疗性流产。继续使用该药物似乎相当安全。进一步积累安全数据将阐明这一问题。
