Prolactin Levels and Pituitary Tumors: Your Questions Answered

Q: Prolactin Levels and Pituitary Tumors: Your Questions Answered

Hello： Generally, elevated prolactin levels are associated with the phenomenon of galactorrhea, with values greater than 70 ng/mL warranting consideration for a head CT scan. <br>If the levels exceed 100 ng/mL, suspicion for a microadenoma of the pituitary gland arises. <br>The d

Prolactin

Hello, I have hyperthyroidism and have been undergoing treatment for 1 year and 9 months.
I have been married for over a year and have not used contraception.
My examination results show a pituitary tumor measuring less than 1 cm.
I know that thyroid issues can cause galactorrhea, but my menstrual cycle is normal, and there is no milk leakage.
Does this count as galactorrhea? When I was first examined, my prolactin level was very high at 180.
After three months of medication, it has only decreased to 0.7.
Is this normal? Why is this happening? Should I stop the medication? Is medication sufficient for treating the tumor, or is surgery a better option? Can medication completely eliminate the tumor? How long will it take to conceive? Are there cases of successful pregnancies after similar situations? How long did it take for them to conceive? Will surgery lead to a complete recovery, and will I no longer need medication? Will I be able to conceive quickly after surgery? I have seen various surgical methods online.
Could you recommend which method I should consider? Will I need to shave my head if the surgery is performed on the brain? How long will it take to conceive? Thank you for taking the time to answer my questions.
I live in Tainan; do you know any specialists at Chi Mei Medical Center who can provide me with professional advice? If I need surgery, which doctor would be the most qualified? Could you please refer me? Thank you.

Xiao Jun, 30~39 year old female. Ask Date: 2004/02/11

Dr. Peng Yiguo reply Obstetrics and Gynecology

Hello: Generally, elevated prolactin levels are associated with the phenomenon of galactorrhea, with values greater than 70 ng/mL warranting consideration for a head CT scan.
If the levels exceed 100 ng/mL, suspicion for a microadenoma of the pituitary gland arises.
The decision to use oral medications or surgical intervention depends on the underlying cause of the elevated prolactin levels.
Factors such as the use of psychiatric medications, medications for peptic ulcers, or the presence of a pituitary tumor should be evaluated, with medication treatment typically considered first.
For example, if your initial prolactin level was 180 ng/mL but decreased to 0.7 ng/mL after treatment, you may consider discontinuing the medication, but it is still necessary to monitor prolactin and thyroid hormone levels.
As long as these hormone levels return to normal, there is a possibility of pregnancy.
Surgical intervention depends on the size of the pituitary tumor, any compressive effects, and the response to medical treatment, and you may consult a neurosurgeon for further guidance.
Chimei Medical Center has a high standard of care, and any obstetrician-gynecologist or neurosurgeon can help clarify your concerns.
Dr.
Peng Yiguo, Department of Obstetrics and Gynecology, Miaoli Hospital.

Reply Date: 2004/02/11

More Info

Understanding prolactin levels and pituitary tumors can be quite complex, especially when considering the implications for fertility and treatment options. Let's break down your concerns and questions regarding your condition.

Prolactin Levels and Symptoms
Prolactin is a hormone produced by the pituitary gland, and elevated levels can lead to a condition known as hyperprolactinemia. This condition can cause various symptoms, including galactorrhea (the production of breast milk not associated with breastfeeding), irregular menstrual cycles, and fertility issues. However, you mentioned that your menstrual cycles are normal and you do not experience any milk leakage, which suggests that you may not be experiencing galactorrhea despite having elevated prolactin levels.

Pituitary Tumors and Prolactin
The presence of a pituitary tumor, particularly a prolactinoma (a benign tumor that secretes prolactin), can lead to elevated prolactin levels. Your initial prolactin level of 180 ng/mL is indeed high, and after three months of treatment, a reduction to 0.7 ng/mL indicates a significant response to medication, which is a positive sign. It is not uncommon for prolactin levels to fluctuate during treatment, and achieving normal levels can take time.

Treatment Options
1. Medication: The first-line treatment for prolactinomas is usually medication, specifically dopamine agonists like cabergoline or bromocriptine. These medications can effectively lower prolactin levels and shrink the tumor. Many patients experience significant improvement with medication alone, and in many cases, the tumor can shrink considerably.

2. Surgery: Surgery is typically considered if medication is ineffective, not tolerated, or if there are significant complications (like vision problems due to tumor size). The surgical approach can vary, but transsphenoidal surgery (through the nose) is a common method that does not require shaving the head.
3. Monitoring: Regular follow-up with MRI scans and prolactin level checks are essential to monitor the tumor's response to treatment and to adjust therapy as needed.

Fertility Considerations
Regarding your concerns about fertility, many women with prolactinomas can conceive successfully after their prolactin levels are normalized, either through medication or after surgery. The timeline for conception can vary widely among individuals. Some women may conceive within a few months of treatment, while others may take longer. It is essential to have a discussion with your healthcare provider about your specific situation and any additional fertility evaluations that may be necessary.

Recommendations
- Do Not Stop Medication: It is crucial to continue your medication unless advised otherwise by your healthcare provider. Stopping treatment can lead to a resurgence of symptoms and elevated prolactin levels.

- Consult a Specialist: Since you are looking for a specialist in Tainan, I recommend seeking an endocrinologist or a neurosurgeon with experience in pituitary disorders. Hospitals like Chi Mei Medical Center often have specialists in these fields. You can inquire about their endocrinology or neurosurgery departments for recommendations.

- Follow-Up: Regular follow-ups are essential to monitor your prolactin levels and the size of the tumor. Your doctor will guide you on the appropriate intervals for these checks.

Conclusion
In summary, while your situation may seem daunting, there are effective treatments available for managing elevated prolactin levels and pituitary tumors. With appropriate medical care, many patients achieve normalization of their prolactin levels and can conceive successfully. Always consult with your healthcare provider before making any changes to your treatment plan, and consider seeking a second opinion if you feel uncertain about your current care.

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