Post-Surgery Complications After Pituitary Tumor Removal

Are there any sequelae after resection of a pituitary tumor?

I underwent surgery nine years ago to remove a pituitary tumor (0.8 cm).
Prior to that, I had been on medication for two years, but the tumor did not disappear, leading to the recommendation for surgery.
Before the surgery, my prolactin levels were as high as 200, later decreasing to around 40-80, but I never experienced galactorrhea.

1.
Since then, my menstrual cycle has been irregular, often occurring every two to three months, with each period accompanied by blood clots and severe abdominal pain on the second and third days.
Six years ago, I experienced a three-month absence of menstruation, during which I gained nearly 10 kilograms in just one month and fell into a state of hypersomnia (constantly feeling sleepy).
After an evaluation by an endocrinologist, it was found that I had insufficient gonadotropins and adrenal hormones.
I improved after taking medication for two to three months, and the doctor advised me to maintain a regular monthly menstrual cycle.
2.
In 1992, I unexpectedly became pregnant (previously, doctors had said I might be infertile) and gave birth to a healthy baby girl.
However, I had very little breast milk postpartum, even after nursing 1-2 times a day for two months; there was not enough milk for the baby, so I had to switch to formula.
3.
Eight months before giving birth, I experienced unbearable itching all over my body.
The doctor said it would resolve after delivery, but it has been over a year, and the itching persists.
I have consulted various dermatologists and rheumatologists, and despite receiving injections and medications, the itching has not improved.
4.
Due to the unbearable itching, I went for an evaluation at the endocrinology department, where I unexpectedly found out that my LH level was 10.7 and my cholesterol was 234.
The doctor diagnosed me with polycystic ovary syndrome (PCOS) and advised me to control my weight (currently 163 cm and 87 kg; I don’t eat much, but I gain weight quickly).
Otherwise, my metabolism could soon be affected.
Recently, I have been feeling emotionally unstable and often think that if I had not undergone surgery to remove the pituitary tumor, I might not have so many endocrine issues today.
However, my family and friends comfort me by saying that if I hadn't had the surgery, it could have turned into a malignant tumor.
I would like to ask the doctor, is this true? Also, are the issues I mentioned earlier side effects of the surgery? How should I face my body moving forward? Are there any methods to prevent endocrine abnormalities?

Tòngkǔ de māmī, 30~39 year old female. Ask Date: 2005/04/18

Dr. Huang Jianxun reply Obstetrics and Gynecology

Based on your description, the organic changes in your pituitary gland appear to meet the criteria for surgery.
However, it is essential to continue collaborating with your physician post-surgery and to have long-term follow-up to optimize the adjustment of all your hormones to their best state.

Reply Date: 2005/04/18

More Info

After undergoing surgery for a pituitary tumor, it is not uncommon to experience a range of complications and symptoms related to hormonal imbalances and other physiological changes. Your concerns about irregular menstruation, weight gain, fatigue, and persistent itching are valid and warrant a comprehensive understanding of the potential post-surgical effects.

1. Irregular Menstruation and Hormonal Imbalances: The pituitary gland plays a crucial role in regulating hormones that control the menstrual cycle. After the removal of a pituitary tumor, it may take time for the hormonal levels to stabilize. Irregular periods, the presence of blood clots, and severe abdominal pain during menstruation can be indicative of hormonal fluctuations or imbalances. It is essential to follow up with an endocrinologist who can monitor your hormone levels and provide appropriate treatment options, such as hormone replacement therapy, if necessary.

2. Weight Gain and Fatigue: The symptoms you describe, including rapid weight gain and excessive sleepiness, may be linked to hormonal deficiencies, particularly involving the adrenal and gonadal hormones. Conditions like adrenal insufficiency can lead to fatigue and weight changes. Your previous treatment with medications suggests that your healthcare provider is aware of these issues, but ongoing monitoring is crucial. Lifestyle modifications, including a balanced diet and regular exercise, can help manage weight and improve energy levels.

3. Postpartum Issues: The challenges you faced with breastfeeding and low milk supply can also be attributed to hormonal changes following pituitary surgery. Prolactin, the hormone responsible for milk production, may not be adequately regulated post-surgery. It is not uncommon for women who have had pituitary surgery to experience difficulties with lactation. Consulting with a lactation specialist may provide additional strategies to enhance milk supply if you choose to breastfeed in the future.

4. Persistent Itching: The itching you have experienced for over a year could be related to several factors, including hormonal changes, skin conditions, or even stress. Since you have seen multiple specialists without resolution, it may be beneficial to revisit your primary care physician or a dermatologist to explore further diagnostic options. They may consider allergy testing or other evaluations to determine the underlying cause of your symptoms.

5. Polycystic Ovary Syndrome (PCOS): The diagnosis of PCOS can complicate your situation, as it is often associated with insulin resistance, weight gain, and irregular menstrual cycles. Managing PCOS typically involves lifestyle changes, such as diet and exercise, and sometimes medication to regulate menstrual cycles and manage symptoms. Working closely with an endocrinologist or a reproductive specialist can provide tailored strategies to address both PCOS and the aftermath of your pituitary surgery.

6. Emotional Well-being: It is understandable to have feelings of regret or anxiety regarding your surgery and its outcomes. It is essential to acknowledge these emotions and consider speaking with a mental health professional who can help you process these feelings and develop coping strategies. Support groups for individuals with similar experiences can also provide comfort and understanding.

7. Preventing Endocrine Abnormalities: While some hormonal changes may be unavoidable after pituitary surgery, maintaining a healthy lifestyle can significantly impact your overall well-being. Regular check-ups with your healthcare provider, a balanced diet, regular physical activity, and stress management techniques can help mitigate some risks associated with endocrine abnormalities.

In conclusion, while the surgery was necessary to remove the tumor and prevent potential malignancy, it is essential to address the post-operative complications you are experiencing. Continuous communication with your healthcare providers, adherence to treatment plans, and proactive management of your symptoms will be crucial in navigating your recovery and maintaining your health moving forward. Remember, you are not alone in this journey, and seeking support from healthcare professionals and loved ones can make a significant difference.

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