Case-2: A 27-year-old female with recurrent macroprolactinoma contemplating pregnancy

Case summary

A 27-year-old female presented with the complaint of primary subfertility; attended to an endocrinologist with an inquisitiveness to explore if her subfertility is due to any hormonal problems. She had a significant past medical history of pituitary macroadenoma for which she had neurosurgical intervention but no follow up since surgery. She had been amenorrhoic since surgery. Further evaluation established the diagnosis of recurrent macroprolactinoma. Problems regarding management of this case are:

1. Management of recurrent macroprolactinoma (Medical management vs repeat surgery)
2. Should we encourage pregnancy in such a case? (Risk of tumor expansion; pituitary apoplexy)
3. Should we be hopeful for achieving spontaneous conception?
4. Management of pregnancy in macroprolactinoma