5mm microadenoma

I was diagnosed with a 5mm microadenoma and I am still waiting to see an endocrine neurologist. What can I expect at my Dr.'s appt. What questions should I ask? What tests should be done? What is the best treatment for microadenomas? I am a 34 y/o female, and am having headaches almost every day and I have a significant cardiac history. My hormone levels are normal including prolactin, though I do have galactorrhea. My pcp and gyn think the galactorrhea is due to having open heart surgery in Jan. for endocarditis from an infected pacemaker and to close a hole between the L and R atrium. Right after my surgery I noticed 3 small black spots, the largest is about 2mm, in the middle of my vision in my L eye. Could this be from the microadenoma? I have many floaters, but these are different than the ones I am used to.
Thank you for your time!
Carolyn

[rumpled]

I am glad you are going to see a neuro-endocrinologist.
A good one should take a complete history, do an exam, and ask for a lot of blood work that includes 24 hour blood tests. They should check all your hormones - pituitary and the rest in order to see what has been impacted. Often they will also check a few things along the lines of immunity too and some vitamins and electrolytes.

As for being normal with galactorrhea - I had that too but I still had a prolactinoma. Only the docs told me mine was an incidentaloma and to ignore it so I only found out the truth 12 years later when it came out in surgery for Cushing's disease. I had two tumors. I know several other cases of normal levels with a secreting tumor.

Treatment for pituitary tumors vary on what type it is. If is a prolactinoma, then it is often treated with medications - dostinex or parlodel. If it is another type, then the treatments can vary from medications to surgery.

BTW, hormones can interfere with the heart - for instance, I had to start seeing a cardiologist before my pituitary surgery. Did your heart issue have a hormonal component?

As for the eyes, you should also see a neuro-opthomologist who can test your visual fields, check your optic nerve and make sure everything is ok. Normally the issue with pituitary is that the vision to the sides is impacted, not spots in the middle.

[SarahB79]

do not let your dr. treat you with dostinex or cabergoline if you have history of cardiac problems already.  This causes known valve damage!!!!! Bromocriptine will need to be the drug of choice to stop your lactation, even if the prolactin isnt elevated.  Are you on birth control or any other medication?  Cuz some medications can fool the tests and going off them for about 4 weeks can make the levels return to what they would be to indicate the marker of what treatment you should have.  Bromocriptine is taken daily and has some side effects like dizziness and nausea, but it usually subsides after a few weeks.  

Make sure you take your medical history with you when you see the endocrinologist as it will be very important to help them cover all the basis and medicate or treat you correctly.  

Here is some info on pituitary tumors and hormones they can affect: Have the dr. test all these, plus CBC, A1c, Alderosterone, Testosterone, Cortisol, etc.

Adrenocorticotropic Hormone (ACTH) - ACTH triggers the adrenals to release hormones such as cortisol and aldosterone. These hormones regulate carbohydrate/protein metabolism and water/sodium balance, respectively.

Growth Hormone (GH) - This is the principal hormone that regulates metabolism and growth.

Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH) - These hormones control the production of sex hormones (estrogen and testosterone).

Melanocyte-Stimulating Hormone (MSH) - MSH regulates the production of melanin, a dark pigment, through melanocytes in the skin. Increased melanin production produces pigmentation or tanning of the skin. Some conditions causing excessive production of melanocyte-stimulating hormone may lead to darkening of the skin.

Prolactin (PRL) - This hormone stimulates secretion of breast milk.

Thyroid Stimulating Hormone (TSH) - TSH stimulates the thyroid gland to release thyroid hormones. Thyroid hormones control basal metabolic rate and play an important role in growth and maturation. Thyroid hormones affect almost every organ in the body.

Vasopressin, also called anti-diuretic hormone (ADH) - This hormone promotes water retention.

Pituitary Adenomas

Pituitary adenomas are the fourth most common intracranial tumor after gliomas, meningiomas and schwannomas. The large majority of pituitary adenomas are benign (not malignant) and are fairly slow growing. Even malignant pituitary tumors rarely spread to other parts of the body. Adenomas are by far the most common disease affecting the pituitary. They more commonly affect people in their 30s or 40s, although they are diagnosed in children as well. Most of these tumors can be successfully treated. Pituitary tumors can vary in size and behavior. Tumors that produce hormones are called functioning tumors, while those that do not produce hormones are called nonfunctioning tumors.

Diagnosis

When a pituitary tumor is suspected, a physician will perform a physical examination, as well as vision testing to detect visual field deficits, such as loss of peripheral vision. Hormone testing of the blood and urine and imaging studies of the brain are used to confirm diagnosis. The most accurate diagnostic imaging test is magnetic resonance imaging (MRI), performed with and without a contrast agent.

Treatment

Early intervention provides the best chance for cure or control of the tumor and its side effects. There are three types of treatment used for pituitary tumors: surgical removal of the tumor, radiation therapy using high-dose x-rays/proton beams to kill tumor cells, and medication therapy to shrink or eradicate the tumor and control side effects.