Prolactinoma (cont.)

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.

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.

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.

Source: MedicineNet.com
http://www.medicinenet.com/prolactinoma/article.htm