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.
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.
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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