Robert Ferry Jr., MD, is a U.S. board-certified Pediatric Endocrinologist. After taking his baccalaureate degree from Yale College, receiving his doctoral degree and residency training in pediatrics at University of Texas Health Science Center at San Antonio (UTHSCSA), he completed fellowship training in pediatric endocrinology at The Children's Hospital of Philadelphia.
Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.
Prolactinomas are usually initially treated with medications.
Surgery is considered if the medications cannot be tolerated, or if
they are not effective.
The medical treatment may be only partially
successful. In such cases, the medications may be combined with
surgery or radiation therapy.
What medications are used to treat
prolactinomas?
Because dopamine is the chemical in the brain that normally
inhibits prolactin secretion, doctors may treat prolactinomas with
drugs that act like dopamine such as
bromocriptine (Parlodel) or
cabergoline (Dostinex).
Both bromocriptine (Parlodel) and cabergoline (Dostinex) have been
approved by the U.S. Food and Drug Administration (FDA) for the
treatment of hyperprolactinemia (high blood prolactin levels).
Bromocriptine (Parlodel) is also approved for the treatment of
infertility. Treatment with these drugs is successful in shrinking
the tumor and returning prolactin levels to normal in approximately
80% of cases, or four out of every five patients.
Bromocriptine (Parlodel) is associated with side effects such as nausea and dizziness. To avoid these side effects, it is important that the dose of bromocriptine be increased slowly. Transvaginal use of bromocriptine is documented as a safe alternative route for delivery if nausea is excessive. In general, side effects typically disappear while the drug continues to lower prolactin levels.
Bromocriptine (Parlodel) treatment should not be interrupted
without consulting a qualified endocrinologist. Prolactin levels
often rise again in most people when the drug is discontinued. In
some, however, prolactin levels remain normal, so the doctor may
suggest reducing or discontinuing treatment every two years on a
trial basis.
Cabergoline (Dostinex) is also associated with side effects such as nausea and dizziness, but these effects are usually less common and less severe than with bromocriptine. As with bromocriptine therapy, side effects may be avoided if treatment is started gradually. Recently, the use of Dostinex has been linked to heart valve problems. Many
endocrinologists are using Dostinex as a last resort if bromocriptine simply cannot be tolerated.
If side effects develop with a higher dose, the doctor may return to the previous dosage. If a patient's prolactin blood level remains normal for
six months, the doctor might consider stopping treatment.
Medical therapy can often shrink a prolactinoma such that surgery is not required.
Lung cancer kills more men and women than any other form of cancer. Eight out of 10 lung cancers are due
to tobacco smoke. Lung cancers are classified as either small cell or non-small
cell cancers.
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the
rate of thyroid hormone production is controlled by the brain at the pituitary.
Hypothyroidism is a very common condition and the symptoms of hypothyroidism are
often subtle.
Low testosterone can affect both men and women. Causes of low testosterone in males include undescended testicles and injury to the scrotum. Low testosterone in females includes ovary conditions. Treatment for low testosterone in men includes testosterone replacement therapy. Currently there is no FDA approved testosterone treatment for women.
Menopause is the time in a woman's life when menstrual periods permanently stop, also called the “change of life." Menopause symptoms include hot flashes, night sweats, irregular vaginal bleeding, vaginal dryness, painful intercourse, urinary incontinence, weight gain, and emotional symptoms such as mood swings. Treatment of menopausal symptoms varies, and should be discussed with your physician.
Normal vaginal bleeding (menorrhea) occurs through the process of menstruation. Abnormal vaginal bleeding in women who are ovulating regularly most commonly involves excessive, frequent, irregular, or decreased bleeding. Causes of abnormal may arise from a variety of conditions.
Impotence, also known as erectile dysfunction, is a common
problem among men characterized by the consistent inability to sustain an
erection sufficient for sexual intercourse or the inability to achieve
ejaculation, or both. Impotence can have emotional causes but most often it is
due to a physical problem.
A peptic ulcer is an ulcer in the lining of the stomach, duodenum, or esophagus. Ulcer formation is related to Helicobacter pylori bacteria in the stomach, use of anti-inflammatory medications, and cigarette smoking.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Cushing's syndrome, sometimes referred to as hypercortisolism, is a hormonal disorder caused by prolonged exposure to high levels of the hormone cortisol. Symptoms may include obesity, thinning arms and legs, a rounded face, and increased fat around the neck. Some causes of Cushing's syndrome is from taking glucocorticoid hormones such as prednisone for inflammatory diseases. Treatment for Cushing's syndrome depends on the cause.
The breast generally refers to the chest, however, more specifically, to the mammary gland. The mammary gland is a milk producing gland comprised largely of fat. Within the mammary gland is a complex network of branching ducts. The ducts exit from sac-like structures called lobules, which can produce milk in females. The darkened area around the nipple is called the areola. Common medical concerns in regard to the breast include breast lumps, breast cysts, breast cancer, and breast infections.
Infertility is the diminished ability to conceive a child. The primary cause of infertility in men is a sperm disorder. In women, the primary cause of infertility is an ovulation disorder. Most forms of infertility can be treated. Conventional infertility therapies include drugs or surgery.
It's important to know whether you will breastfeed or bottle-feed your baby prior to delivery, as the breasts' ability to produce milk diminishes soon after childbirth without the stimulation of breastfeeding. Breast milk is easily digested by babies and contains infection-fighting antibodies and cholesterol, which promotes brain growth. Formula-fed babies actually need to eat somewhat less often since formula is less readily digested by the baby than human milk. This article explores the advantages and disadvantages of both forms of feeding.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
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