Benign tumor causes concern

DEAR DR. GOTT: Fifteen years ago, I was diagnosed with a pituitary prolactin producing adenoma. I was told it is not cancerous and isn’t operable. I was on a medication called Permax for 13 years until it was taken off the market. My endocrinologist then prescribed bromocriptine, 2.5 milligrams, that I took for a year even though it made me sick. She then came up with the idea of having the pill crushed and placed in a suppository, which I inserted in my vagina at bedtime nightly. After using it for four months, it brought my prolactin down from 156 to 124, but I had yeast infections, got sore, and experienced a burning sensation.

I’m now off my medication and have blood work every two months to check my prolactin. I suffer from headaches at times and don’t know whether it is some sort of swelling of my pituitary. For 15 years, my doctor has had me taking 30 milligrams of Hydrocort daily for inflammation.

I’m hoping you may know more than my doctor. I have thought about going to Cleveland Clinic in Ohio, but I want to know what you think first.

DEAR READER: Prolactinomas are the most common form of benign tumor of the pituitary gland. The pituitary is located in the base of the brain and plays an important role in metabolism, reproduction, growth and development. A hormone known as prolactin in the pituitary stimulates the breasts to produce milk during pregnancy. Symptoms of prolactinoma are caused by pressure of the tumor on surrounding tissue or too much prolactin in the bloodstream.

High levels of the hormone can cause infertility, loss of libido and changes in menstruation that vary from person to person. Women may find menstruation ceases or becomes irregular, vaginal dryness can occur, and those who are not pregnant may produce breast milk. Men with the condition may experience erectile dysfunction, headaches and eye problems.

Diagnosis can be made through laboratory testing of prolactin blood levels. When levels are higher than normal, a physician may test for hypothyroidism, tie in prescribed medications known to raise prolactin secretion, or consider injury to the chest wall itself.

Because the optic nerve sits just above the pituitary gland, a physician might order an eye exam with visual-field measurements.

Treatment is focused on reducing levels to normal, correcting visual abnormalities, reducing the size of the tumor, and restoring normal function of the gland. Dopamine is the chemical that inhibits secretion of the hormone. As such, dopamine agonists bromocriptine or cabergoline may be drugs of choice. The purpose of these drugs is to perform as naturally occurring substances. Both have been approved by the Food and Drug Administration for the treatment of hyperprolactinemia.

The bromocriptine you were prescribed appears to have a well-established safety record, even though side effects such as nausea and dizziness can occur. To combat possible unwanted effects, the medication is commonly begun slowly with 1/4 to 1/2 of a 2.5-milligram tablet taken at bedtime with a snack. The dosage may be increased gradually to 7.5 milligrams daily. The medication is short acting and should be taken two or three times each day. Prolactin levels have been shown to rise when the drug is discontinued.

Cabergoline is newer and more expensive, but it has fewer side effects, and the drug may be more effective than bromocriptine. Studies indicate prolactin levels will likely remain more normal after cabergoline therapy than bromocriptine, but further research is necessary before we know for sure.

Surgery should be considered only if conservative methods of treatment fail to produce effective results. If a tumor must be removed surgically, the procedure is commonly performed through the nasal cavity. If the tumor is so large this cannot be accomplished, access will be made through an opening in the skull.

Hyperprolactinemia can lower the production of estrogen. Women with inadequate production are at increased risk of developing osteoporosis and should undergo periodic bone-density testing. Coordinate a plan of regular exercise, and supplement additional calcium with vitamin D.

One method of remaining informed of cutting-edge progress and taking an active role in your health care is by entering available clinical trials. Information can be obtained through www.ClinicalTrials.gov.

Tell your endocrinologist about your headaches. Perhaps an MRI is in order, or there may be yet another cause for them that should be investigated. Following that, if you feel you will be better served with a visit to Cleveland Clinic, follow through with the plan. Good luck.

To provide related information, I am sending you a copy of my Health Report “Thyroid Disorders.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.