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 > *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html