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Introdução: Os prolactinomas são os tumores benignos mais frequentes da hipófise,
afetando mais as mulheres em idade fértil. Durante a gravidez, verifica-se um aumento
fisiológico da hipófise, havendo um risco acrescido de expansão tumoral. Os agonistas
dopaminérgicos são o tratamento de primeira linha, sendo extremamente eficazes em
restaurar a fertilidade. A sua interrupção é aconselhada aquando do diagnóstico de
gravidez, pelo risco de ocorrência de malformações fetais.
Objetivos: Esta dissertação procura esclarecer quais os efeitos do tratamento
farmacológico dos prolactinomas durante a gravidez, tanto a nível fetal – com a ocorrência
de malformações e abortos – como a nível materno, com a ocorrência de sintomas
compressivos, expansão tumoral ou até remissão do mesmo. Adicionalmente, abordar a
reintrodução da terapêutica e verificar a sua segurança e eficácia no tratamento.
Materiais e Métodos: Para a realização desta monografia foi elaborada uma pesquisa de
artigos científicos referentes ao tema, publicados na base de dados “PubMed/MEDLINE”,
com recurso às palavras-chave “pregnancy”, “prolactinoma”, “treatment”. A pesquisa
englobou ensaios clínicos, estudos observacionais e estudos retrospetivos, complementada
com a consulta de documentos de entidades científicas na área em análise.
Resultados: Identificaram-se 16 artigos que abordaram o impacto que o tratamento
farmacológico exerce no controlo de um prolactinoma e na saúde das crianças cujas mães
foram submetidas a terapia médica na pré-conceção/primeiro trimestre. A maioria dos
estudos não reportaram alterações relevantes na ocorrência de abortos e de complicações
fetais, comparativamente com a população geral. Foi observada uma regressão tumoral nos
casos excecionais onde se efetuou terapêutica durante a gravidez.
Discussão: Os dados disponíveis relativamente aos desfechos materno-fetais da utilização
de terapia médica dos prolactinomas são escassos. Os estudos existentes carecem de
amostras com relevância significativa, sendo predominantemente efetuados apenas em
mulheres que interrompem a terapêutica após conhecimento da gravidez. No entanto, a
utilização de agonistas dopaminérgicos aparenta ser segura e não apresentar riscos de
malformações fetais ou ocorrência de abortos, assim como se verifica uma redução ou até
remissão tumoral após as gestações em que foi empregue previamente a engravidar o
tratamento médico. Conclusão: É necessária a realização de mais estudos prospetivos, com uma amostra mais
extensa, que permita corroborar os resultados obtidos em amostras menores e de modo a
existir um consenso internacional sobre o uso correto da terapêutica de prolactinomas, na
gravidez.
Introduction: Prolactinomas are the most common benign pituitary tumours, affecting mostly women in fertile age. During pregnancy, there is a physiological increase of the pituitary gland, with an increased risk of tumour expansion. Dopamine agonists are the first-line treatment and are extremely effective in restoring fertility. Their discontinuation is advised when pregnancy is diagnosed, due to the possible occurrence of fetal malformations. Objectives: This dissertation seeks to clarify the effects of the pharmacological treatment of prolactinomas during pregnancy both at the fetal level – with the occurrence of malformations and abortions – and at the maternal level – with the occurrence of compressive symptoms, tumour expansion or even its remission. Additionally, it addresses the reintroduction of therapy and its safety and efficacy. Materials and Methods: To develop this thesis, a search was carried out on scientific articles related to the topic, published in the “PubMed/MEDLINE” database, using the keywords “pregnancy”, “prolactinoma”, “treatment”. The research covered clinical trials, observational studies, retrospective studies, complemented with the consultation of documents from scientific entities in the area. Results: 16 articles were identified that address the impact that pharmacological treatment exerts on the control of a prolactinoma and in children whose mothers underwent medical therapy in the preconception/first trimester. Most studies did not report relevant changes in the occurrence of abortions and the presentation of fetal complications, compared to the general population. Tumour regression was observed in exceptional cases where therapy was carried out during pregnancy. Discussion: Available data regarding maternal-fetal outcomes from the use of medical therapy for prolactinomas are limited. Existing studies lack samples of significant relevance, being predominantly performed only in women who discontinue therapy. However, the use of dopamine agonists does not seem to present risks of fetal malformations or occurrence of miscarriages, as well as it is notable a reduction or even tumour remission after pregnancies in which medical treatment was initiated. Conclusion: It is necessary to conduct more prospective studies, with a more extensive sample, to corroborate the results obtained in smaller samples and to have an international consensus on the correct use of therapy of prolactinomas in pregnancies.
Introduction: Prolactinomas are the most common benign pituitary tumours, affecting mostly women in fertile age. During pregnancy, there is a physiological increase of the pituitary gland, with an increased risk of tumour expansion. Dopamine agonists are the first-line treatment and are extremely effective in restoring fertility. Their discontinuation is advised when pregnancy is diagnosed, due to the possible occurrence of fetal malformations. Objectives: This dissertation seeks to clarify the effects of the pharmacological treatment of prolactinomas during pregnancy both at the fetal level – with the occurrence of malformations and abortions – and at the maternal level – with the occurrence of compressive symptoms, tumour expansion or even its remission. Additionally, it addresses the reintroduction of therapy and its safety and efficacy. Materials and Methods: To develop this thesis, a search was carried out on scientific articles related to the topic, published in the “PubMed/MEDLINE” database, using the keywords “pregnancy”, “prolactinoma”, “treatment”. The research covered clinical trials, observational studies, retrospective studies, complemented with the consultation of documents from scientific entities in the area. Results: 16 articles were identified that address the impact that pharmacological treatment exerts on the control of a prolactinoma and in children whose mothers underwent medical therapy in the preconception/first trimester. Most studies did not report relevant changes in the occurrence of abortions and the presentation of fetal complications, compared to the general population. Tumour regression was observed in exceptional cases where therapy was carried out during pregnancy. Discussion: Available data regarding maternal-fetal outcomes from the use of medical therapy for prolactinomas are limited. Existing studies lack samples of significant relevance, being predominantly performed only in women who discontinue therapy. However, the use of dopamine agonists does not seem to present risks of fetal malformations or occurrence of miscarriages, as well as it is notable a reduction or even tumour remission after pregnancies in which medical treatment was initiated. Conclusion: It is necessary to conduct more prospective studies, with a more extensive sample, to corroborate the results obtained in smaller samples and to have an international consensus on the correct use of therapy of prolactinomas in pregnancies.
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Keywords
Gravidez Hiperprolactinemia Prolactinoma Tratamento Farmacológico