Poster Session

P10. Spontaneous pregnancy after trans-sphenoidal resection of a microadenoma refractory to medical treatment. A case report.

Berta Martín Cabrejas (ES), María Jose García Rubio (ES)

[Martín Cabrejas] Hospital Fundación Alcorcon, Madrid, [García Rubio] Fundación, Alcorcon. Spain.

Hyperprolactinemia is an endocrine disorder with a high prevalence in general population, being responsible of approximately 5% cases of infertility, in addition to other disorders such as amenorrhea, menstrual irregularities, or galactorrhea. Among the many causes of hyperprolactinemia, it is included the pituitary microadenoma, which is defined as a prolactinoma smaller than 10 mm and it usually produces mild to moderate hyperprolactinemia. This type of adenomas usually responds to treatment with dopamine agonists, achieving lower prolactin levels and restoring fertility in 90% of cases. After so, it is possible to achieve similar pregnancy rates with ovulation induction than the ones achieved in infertile women due to other causes. Only 10% of patients with microadenoma require surgical treatment, being the main reason the refractoriness to medical treatment and less frequently the intolerance to side effects. We present the case of a 32-year-old woman with a history of secondary amenorrhea and 1 year infertility. Also she had galactorrhea and headache. - Laboratory findings: Estradiol 29 pg/ml; Follicle-stimulating hormone 6.26 mUI/ml; Luteinizing hormone 5.03 mUI/ml; Thyroid-stimulating hormone 5 ug/dl; Prolactin levels: 90 ng/ml. - Gynecologic ultrasound: Anteverted and regular uterus. Endometrial: 1.5mm. Normal ovaries. - Nuclear magnetic resonance: Ptuitary adenoma 5x4.5x5.6mm - Echocardiography; normal - Hysterosalpingography: normal. Medical therapy with Cabergoline was initiated, without getting restored normal prolactin levels despite high doses (2 mg/week). The patient report fatigue, nausea, vomiting and intolerance to the side effects of the drug. She was derived to neurosurgery service where transsphenoidal resection was practiced. Subsequently it was started an unsuccessful artificial insemination cycle. Before beginning a new cycle, the patient got spontaneous pregnancy, which is currently enrolling without incidences