Pituitary Tumor

I was diagnosed with a prolactin secreting tumor a few years ago. It was only 8mm. I have been taking medication to control the size and prolactin levels. I had gone about 4 months or so without my medication because I did not have insurance at the time. I began to experience small migraines, always tired and not myself. My medications are very expensive and if I ever have to go without medication again I worry about how I can afford it. Would it be best to consider surgery even if it is small in size? Would it be risky? Possibly another hormone to not function properly?

[Esteban Cheng-Ching, MD]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to obtain a history, examine you, I cannot tell you what is the best treatment for you. However, I will try to provide you with some useful information.
Prolactin producing tumors are more amenable to treatment than other types of pituitary tumors. The manifestations from a Prolactinoma can be produced by multiple causes like the mass effect on local structures, with symptoms like headaches or visual field disturbances. Also the Prolactin itself can produce symptoms like menstrual problems, breast secretions, decreased libido and decreased energy, as well as impotence. Prolactinomas can produce mass effect affecting the production of other hormones of the pituitary, and therefore a comprehensive evaluation is required to detect of there are other hormonal deficiencies or abnormal production.
Prolactinomas can be 1cm in which they are macroadenomas. On either one the initial treatment of choice is medical therapy with dopamine agonists like Cabergoline, Bromocriptine or Pergolide. Certainly these medications can have side effects as any other medication, however they are used because they are very effective in reducing the Prolactin production as well as the size of the prolactinomas. Surgery is recommended only when the patient does not respond to medical therapy (medications), or the tumor is so large that decompression is required. The surgery for these types of tumors is the transsphenoidal approach (through the nose). Of course every surgical intervention carries some degree of risk, and if medications are working, surgery should not be the first option. The risks range from risks associated with the anesthesia, to risk of the procedure itself, like bleeding, infection, lesions to adjacent structures. Also surgical resection in some cases is not 100% curative, and some patients may have recurrence of the tumors.
Stopping medications without a medical recommendation can be risky, and in the case of medications for prolactinoma, this can lead to growth of the tumor, or increase in the production of prolactin. Headaches are a common manifestation, and it is difficult to determine if what you have experienced is migraines or headaches from prolactinoma.
As I said, based on your description I cannot tell you what the best option is for you. I think you should discuss your concerns with your physician, obtain a specialized opinion from an Endocrinologist, and restart the therapy recommended by them. Other treatment options can be explored as well, but you should discuss this with your physicians.
I hope this information is useful.