Prolactinoma (cont.)
What is the surgical treatment of a prolactinoma?
The surgical treatment of prolactinomas involves delicately
opening the brain to remove the tumor in the pituitary gland.
The results of surgery depend a great deal on tumor size and prolactin level as well as the skill and experience of the neurosurgeon. The higher the prolactin level, the lower the chance of normalizing serum prolactin. At best, surgery corrects prolactin levels in 80% of patients whose blood prolactin level is below 250 mg/mL. Even in patients with large tumors that cannot be completely removed, drug therapy may be able to return serum prolactin to the normal range after surgery. Drug therapy may also be started before surgery to
"debulk" the tumor for the surgical procedure. Depending on the size of the tumor and how much of it is removed, studies show that in 20% to 50% of cases, the tumor will return, usually within
five years.
How do I choose a skilled neurosurgeon?
Because the results of surgery are so dependent on the skill and
knowledge of the neurosurgeon, patients should ask the surgeon about
the number of operations he or she has performed to remove pituitary
tumors, and for success and complication rates in comparison to major
medical centers. Surgeons who have performed many hundreds or even
thousands of such operations usually produce the best results.
Does a prolactinoma affect pregnancy and oral contraceptives?
If a woman has a small prolactinoma, there is usually no reason
that she cannot conceive and have a normal
pregnancy after successful
medical therapy. The pituitary enlarges and prolactin production
increases during normal pregnancy in women without pituitary
disorders. Women with prolactin-secreting tumors may experience
further pituitary enlargement and must be closely monitored during
pregnancy. However, damage to the pituitary or eye nerves occurs in
less than one percent of pregnant women with prolactinomas. In women
with large tumors, the risk of damage to the pituitary or eye nerves
is greater. If a woman has already completed a successful pregnancy,
the likelihood of future successful pregnancies is extremely high.
A woman with a prolactinoma should discuss her plans to conceive
with her physician so she can be carefully evaluated prior to
pregnancy. This evaluation typically includes a magnetic resonance
imaging (MRI) scan to assess the size of the tumor and an eye
examination with measurement of visual fields.
As soon as the patient becomes pregnant, her doctor will usually
advise that she discontinue bromocriptine (Parlodel) or cabergoline
(Dostinex). Patients should consult their hormone specialists
(endocrinologists) promptly if symptoms develop - particularly
headaches, visual changes,
nausea,
vomiting, excessive thirst or
urination, or extreme lethargy. Bromocriptine or cabergoline
treatment may be renewed and additional treatment may be required if
symptoms occur as a result of growth of the tumor during pregnancy.
Next: Do prolactinomas affect oral contraceptives? »
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