Prolactinomas usually lead to infertility and medical treatment restores fertility. Prolactinoma size might increase during pregnancy (2.1% for microprolactinomas and 21% for macroprolactinomas). In this review article, multiple aspects of prolactinomas care during and before pregnancy were discussed. Dopamine agonists are the treatment of choice, if indicated during pregnancy (cabergoline and bromocriptine, while quinagolide is not recommended). It is recommended to stop dopamine agonists in patients with microprolactinoma during pregnancy and follow the patients for mass effect symptoms and visual disturbances every trimester. Dopamine agonists could be stopped as well in a patient with intra-seller macroprolactinomas with more frequent clinical follow ups during pregnancy. Magnetic resonance imaging without contrast is indicated for patients suspected to have tumor enlargement. Dopamine agonists (cabergoline or bromocriptine) are the treatment of choice for invasive/metastatic macroprolactinomas during pregnancy, and neurosurgery is rarely indicated.
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