Fertility & Sterility Vol 36, no 4 October 1981
Bromocriptine as prophylactic therapy in prolactinoma during pregnancy.

"Lactation should not be discouraged in these patients. It is interesting
that one patient in the present study breast-fed her baby despite the
drug-suppressed PRL secretion, which proves the effectivness of suckling
upon milk let-down even when the PRL level has been pharmacologically
suppressed"

Gail Hertz, MD, IBCLC


----- Original Message -----
From: Becky Severson <[log in to unmask]>
Sent: Thursday, September 21, 2000 8:02 AM
Subject: Prolactin-Secreting Pituitary Adenoma


> We have a patient in labor right now who has a prolactin-secreting
pituitary
> tumor.  She was on Parlodel to decrease her prolactin levels in order to
get
> pregnant and has continued on Parlodel throughout her pregnancy.  She
would
> like to breastfeed after delivery. Her Perinatologist plans to keep her on
> the Parlodel post-delivery, as the patient is very concerned about the
> adenoma growing.  Have any of you had a patient with this, who took
Parlodel
> and still was successful at breastfeeding?
>
> Gabbe's "Obstetrics, Normal & Problem Pregnancies", states:
> Breastfeeding is not contraindicated in the presence of a
> prolactin-secreting microadenoma.  Furthermore, treatment with
bromocriptine
> (Parlodel) is safe as well and is apparently not causally related to cases
> of stroke or seizure during the postpartum period.
>
> This morning I spoke with the CNM caring for the patient and we're
thinking
> we might proceed as follows:
>
> - Consider drawing a prolactin level postdelivery to see what her
>   level is (since she's been on Parlodel her whole pregnancy), is it
>   elevated close to the range normally seen in pregnancy?
> - If her serum prolactin level is elevated, initiate early and frequent
>   BF and double-pumping to stimulate lactogenesis.
> - Follow mom closely through our BF follow-up clinic to assure
>   lactation and adequate milk volume after discharge.
> - If the mom's prolactin level post-delivery is low, see if the
>   Peri/mom would consider stopping the Parlodel for a certain period
>   of time to allow lactation to be initiated (ie, a month or more) and
>   then re-implement the Parlodel once milk volume is assured (and
>   attempting to match the time the prolactin normally decreases
>   anyway, so it probably wouldn't hurt to go back on parlodel then)
> - We also spoke to the mom's pediatrician this morning to fill him in
>   on plans for following baby post-delivery.
>
> If any of you have dealt with this and have suggestions on her plan of
care,
> I'd appreciate it.   Should we not be able to establish adequate lactation
> (and can't stop the Parlodel), we'll switch to plan B which supports
> continuation of breastfeeding, but using an SNS or device to provide
> adequate volume for baby.
>
> Sorry for the long post!  Thanks for any advice/suggestions you might
have.
> You can email me privately if you prefer.
>
> Thanks!
>         Becky Severson, RNC, IBCLC
>

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