Pituitary tumor

[chelan2]

Female, age 36.
After a recent CT scan I’ve been diagnosed with a left sided pituitary tumor and have been referred to a neurosurgeon.   Prior to my scan my prolactin level was slightly elevated (67) and I had lost my sense of smell (has now returned).   I’ve had a hysterectomy 2 yrs ago due to a rare ovarian cancer (no chemo necessary and I’m not taking HRT) and I’m not sexually active.  I have not had any milk discharge from my breasts.  How will they distinguish between a prolactin related pituitary tumor and a non-functioning related tumor, is it important to know which kind it is, and what difference does it make in any treatment recommended?  What questions or tests should I be asking for when I meet with the neurosurgeon?  Is surgery usually recommended for either of these tumors?  What is the recovery like from this kind of surgery?  
Thanks for your time.

[CCF-Neuro-M.D.-PW]

If your prolactin is just that level, then it is probably a non-secreting tumor - a secreting tumor would have levels in the hundreds or thousands. It does not make much difference in the management - surgery is done by size as opposed to function. Some 'microadenomas', less than about 3mm, that secrete prolactin can be treated medically by a drug called bromocriptine to shrink them, but this is not effetive is everybody anyway. If the tumor is large enough surgery is usually reccomended as they can fairly safely be removed, nowadays, by an endoscopic technique through the nose - a 'minimally invasive' technique that does not require open surgery, and patients can go home after a shorter time ie 1-2 days.

Good luck

[raven33]

Hi I read your post,I am not a doctor.But wanted to say that with a pituitary tumor,you are usually referred to neurosurgeon who specializes in endocrinology.Has your thyroid levels been checked?It depends on the size before they do surgery,andif it is causing problems.I hope you feel better soon.Raven33

[nosol]

Hello,

How did they find this tumor to begin with?   Were you having headaches?   I believe that prior to making a decision regarding surgery, you should be seen by an opthalmologist who would do "visual field testing" on you to see how much of your peripheral vision is affected.   A pituitary tumor can press on your optic nerves causing constricted peripheral vision -- if this occurs rapidly, that is one of the reasons to do surgery.  

Another would be headaches and/or other hormonal dysfunction.  The easiest way for you to tell is just by assessing how you feel in general.   Are you tired?  Are you gaining / losing weight?  Are you having poor sleep, etc.?   If anything is off, then your endocrinologist would do some testing.

Ultimately, if things are stable, repeat MRI in 6months to see how much the pituitary has grown.   Also, check prolactin.   All of these things will lead your neurosurgeon towards vs against surgery.

Good luck.
ON

[raven33]

Hi I have read some of your posts,I wanted to know if you are a doctor?I have a 33 year old daughter who has had a stroke,the doctors really don't know why.She has speech problems and her body will start to jerk uncontrollably.She all so has a 6 centimeter blood clot on her brain,located on her cerebral artery,the doctor showed where it was,it is up above left ear.She has seen a neurosurgeon,he does not want to do any thing.She started seeing a neurologist because of headaches,the neurologist said that the blood clot wasn't causing the headaches.She still has headaches.She is complaining of her temporal lobe aching a lot now.That is where the stroke happened.Is it possible that the blood clot can becausing the problems?We lieve in the state of Kentucky.We lieve in a part to where there are no good doctors.Does she need to see a specialist may be at one of the bigger hospitals,In Louisville?We are so desperate to find the cause of her problems.Her triglycerides are 422.Strange thing is she doesn't eat fatty foods or that much bread and they are extremely high,especially for her age.Can you may be give me some insight.Sorry to have bothered you.Raven33

[nosol]

Hi.

I am sorry to hear about your daughter and your situation.
I would say that the fact that she had a stroke at such a young age is enough of a warning for her to be seen by a specialist -- preferrably, someone who deals with strokes.   There are many reasons why someone so young has strokes and that has to be evaluated.  Her high triglycerides may be the culprit or they may not but they certainly need to be treated. She may even need to go on medication (UNLESS her stroke was a bleed she should already be on an aspirin).  If we don't find the cause, she may still be at risk for another stroke.  

I am not sure what you mean by a "blood clot near a cerebral artery".  That should not be causing her headaches.  However, if she has a tendency for blood thickening (some young people do, especially if she's a smoker or takes birth control pills) -- she may be at risk for developing either new strokes or blood clots in her cerebral veins.  That needs to be treated right away as well.

Bottom line:  yes, you probably need to find a neurologist in a large academic center, preferrably.   Perhaps, someone who deals with strokes and/or headaches.  They will evaluate your daughter in full and give you direction.   If your daughter starts feeling significantly worse with her headaches -- take her to the nearest Emergency room.

Good luck.
ON

[raven33]

Hi,Thank you for answering my post.The blood clot is on her brain.I don't know how to describe it.It is on her cerebral artery,at first they thought it was a aneurysm.Because to the it looked on the MRI.It was a bulge,is what the neurologist said.Thats why they thought it was a aneurysm.Until they did an angiogram,April of this year.The neurosurgeon,said it was caused by a hard blow to her head.The only thing we could think of was when she was younger,her brother hit her in the head with a 3 inch metal bar.She was knocked out for several hours.Me and her daddy didn't think about it hurting her head internally,because it swelled out wards,and it was not near the blood clot.She was hit in the front,she fell back and hit her head on the ground.She was about 6 years old when this happened.I have done more research,since I posted to you.I came across,CNS vasculitis,because she has had a stroke.All so they where young adults them selves.That's another reason why it caught my eye.Do you think this might be the culprit,for my daughters poor health right now.We are so desperate to find answers.I find my self on the computer for several hours,searching for answers.I hope you don't mind me asking you questions,what state do practice in?Raven33.

[nosol]

It's hard to say what the culprit to your daughter's problems is without examining her fully and checking her blood for things like vasculitis, hypercoagulable state, bleeding disorders, Lyme, etc.    - all possible reasons for someone this young to have either ischemic or hemorrhagic strokes.  

I suggest you take her to a new neurologist and don't forget to bring all of her MRIs / image reports and any blood work she has ever had done for this problem, no matter how old.  

I am not yet a practicing neurologist.

Good luck!