Progress

According to my endocrinologist, there is nothing that I can do to help myself heal.  According to him, my only choice is to wait for the medication to slowly (yet uncertainly) battle the tumor near my pituitary gland.

I don’t believe this for a moment.

I believe that there are several things that anyone can do to improve their health, no matter what their situation.  The basics are extremely important: eating right, exercising regularly, getting enough sleep, and avoiding harmful substances set the foundation for overall health and wellness.  This has been my focus for the past few months, and will continue to be my focus as I track my progress.

And…. I am making progress!  At my most recent endocrinologist’s appointment, my prolactin level measured below 20!  This means that it is within the normal reference range for the first time in who-knows-how long.  I am keeping my medication at it’s current dosage at the endocrinologist’s request.  We are hoping that the level continues to drop–the lower the better.  Also good news: the medication (bromocriptine) isn’t bothering me as much as it used to.  I take it right before bed, and I usually don’t notice any side effects.

All is going well.  Full speed ahead!

Some background on prolactinomas

Let’s start with the pituitary gland, which is a small gland near the base of the brain.  The pituitary is responsible for producing several important hormones, including the hormone prolactin.  Prolactin (also called PRL or lactotrope), is a peptide hormone that has many important functions related to cell growth, the immune system, and pregnancy.  My tumor is called a prolactinoma, meaning that it is a benign tumor near the pituitary glad that is directly producing excess prolactin.  The more generic term “pituitary adenoma” refers to any benign tumor that occurs on or near the pituitary gland (stay with me folks, we’re almost through all the medical terminology).  The term “microadenoma” refers to a tumor that is less than 1cm in diameter, while “macroadenoma” refers to a larger tumor greater than 1cm in diameter.  My tumor is small, 5.1mm by 3.2mm, so my official diagnosis is “microprolactinoma.”

An excess of prolactin in the blood can cause irregular or infrequent periods, temporary infertility, and lactation in women who are not pregnant.  The process of my diagnosis went something like this: my doctor recognized my symptoms as indicative of high prolactin levels and did a blood test to verify, while simultaneously checking my thyroid function (the thyroid plays a part in regulating prolactin and is sometimes responsible for its imbalance).  The normal reference range of prolactin in women who are not pregnant is between 3 and 25 µg/L; mine came back at 116.  As my thyroid function was normal, the doctor sent me to get an MRI.  The MRI confirmed the location and size of the tumor, and I was referred to an endocrinologist for treatment.

Fortunately, prolactinomas (especially microprolactinomas) usually respond well when treated with medication.  If the tumor is large or poses a threat to the occipital nerve, or if the tumor or the patient doesn’t respond well to the medication, then surgery may be considered.  There are two types of medication available in the United States, bromocriptine and cabergoline.  Both medications are dopamine agonists, meaning they act as dopamine in the brain, directly blocking the production of prolactin from the tumor.  The medication helps blood prolactin levels return to normal and hopefully reduce the size of the tumor.  It is possible that a prolactinoma can disappear entirely, but it is also possible that the tumor will never disappear, and prolactin levels will need to be regulated throughout the patient’s life.

If you want to read more about prolactinomas or treatment options, this is the best website that I have found:  http://www.uptodate.com/contents/high-prolactin-levels-and-prolactinomas-beyond-the-basics