Dados do Trabalho

Title

Pregnancy after treatment of hyperprolactinemia: a case report.

Objective

The aim of this study was, in general, to document a case of idiopathic hyperprolactinemia associated with a desire to become pregnant. Thus, the relationship between hyperprolactinemia and pregnancy and the possible risks of treating this pathology during pregnancy were evaluated; we sought to understand which conduct is safer and more appropriate for patients with this condition.

Methods

This research is a quantitative case report study with a descriptive observational design. For this study, the patient's medical record was studied, attended at the Dr. Wladimir Arruda, during the years 2022 and 2023. Thus, the results obtained were analyzed and discussed in association with the current literature.

Results

Hyperprolactinemia is a pathology associated with the presence of supraphysiological levels of prolactin that can lead to changes in the menstrual cycle, reduced libido, galactorrhea and even infertility. Since it is considered drug treatment, it is known that cabergoline is the most used medication, due to its effectiveness and excellent tolerability. However, when dealing with women who wish to become pregnant, the evaluation must be very careful, since there is no clear recommendation for the treatment of idiopathic hyperprolactinemia. At first, when carrying out a thorough analysis of the current literature, it was seen that most of the research carried out regarding the use of cabergoline in pregnant women and/or women with a desire to become pregnant, did not demonstrate the appearance of complications arising from the use of this medication, both in the pregnant woman and in the fetus; concluded that there was not a higher frequency of complications such as abortions, Congenital Abnormalities, among other complications. In the present case, patient X, 24 years old, arrived at the outpatient clinic in August 2021, complaining of galactorrhea and unsuccessful attempts to conceive for three years, since the diagnosis of primary infertility due to idiopathic hyperprolactinemia, a treatment with cabergoline was started; despite having difficult-to-control serum prolactin levels throughout the consultations, the patient managed to get pregnant approximately one year after her first consultation. Thus, she continued using the medication until the 12th week of pregnancy; during pregnancy, she has high levels of blood glucose for large period, but she did not use any control medication. In March 2023, the pregnancy was completed, at 33 weeks and 3 days; the patient was admitted with decompensated blood glucose and non-reassuring cardiotocography, but continued with an uneventful cesarean delivery; considering the data of the newborn, in addition to being premature, he presented an newborn vitality index (APGAR) of 9 at the fifth minute and progressed with respiratory distress syndrome and hypoglycemia at birth, after 16 days in hospital he advanced with weight gain and was discharged. Finally, in the last consultation, in June 2023, she was still breastfeeding and both she and the baby, on physical examination, did not present any abnormality and, when questioned, did not report any complaints relevant to the case.

Conclusion

In the present case, it was seen that, despite the resolution of the infertility complaint after the use of cabergoline, there were external gestational intercurrences (gestational diabetes) that hindered an accurate assessment regarding the safety of treatment with this medication in pregnant women. On the other hand, in the other analyzed studies, most of them concluded that the drug under discussion is not the responsible for the presence of gestational and neonatal intercurrences. Finally, it is worth emphasizing the need for further studies to elucidate, standardize and firmly validate a medical approach in the face of this situation.

Keywords

Hyperprolactinemia; Pregnancy; Cabergoline; Infertility.