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28 Jul 2009
 
 
Pituitary Gland and High Prolactin 
The pituitary gland is considered to be the most important endocrine gland in the body; it is responsible for organizing the function of several endocrines, and the secretion of different hormones. Therefore, it is sometimes called the "Master gland".

As it is known, hormones are responsible for organizing many of the vital processes in the body related to construction, growth, metabolism and reproduction.

The pituitary gland secrets many hormones such as prolactin hormone, growth hormone, the Adrenocorticotropic hormone (ACTH), which organizes the adrenal gland function, the Thyroid Stimulating Hormone (TSH), which regulates the thyroid gland hormonal secretion, the Follicle-stimulating Hormone (FSH), and the Luteinizing Hormone (LH).
 
 

The pituitary gland is a pea-sized gland located between the optic nerves at the base of the skull. Therefore, in case of enlargement of the pituitary gland, the pressure on the optic nerve will lead to visual disturbance and headache.

The non-functioning tumors of the pituitary gland will cause an impairment of the hormone production that will affect the whole body in many ways.

Prolactin Hormone:

Prolactin hormone is one of the important hormones secreted by the pituitary gland. In women, normally the hormone works to stimulate the mammary glands in the breast to produce milk from the early months of pregnancy as preparation for lactation. After childbirth the hormone rates will begin to decline until the mother starts breast feeding, then the hormone rates will increase again in the blood.

The most common tumor of the pitutary gland (called: prolactinoma ) originates from the  part  which secretes prolactin). Prolactinoma is considered to be a benign tumor that will result in an increase in the secretion of the hormone in the body and some distinctive symptoms.

 
 


High levels of prolactin will cause infertility in women, disturbances in the menstrual cycle, and sometimes the absence of menstrual cycle in some women. It might also increase the secretion of the breast milk even though the women are not pregnant or nursing. It also decreases sexual desires as dry vaginal tissues cause painful intercourse.

The main symptoms in men are loss of libido or impotence.  In men there are usually no clear symptoms and signs of the disease. Therefore, the definite diagnosis of the disease might be difficult and established after extensive investigations, until patients suffer from severe headache or visual disturbances.  Men with this disease sometimes will face changes in their energy and sexual desire over a gradual period and it might be due to other problems.

Statistics indicate that the enlargement of the pituitary gland affects 14 clinical cases per 100 thousand. It is not known what causes the emergence of the pituitary gland tumor, nor if it is of hereditary nature.

There are other reasons for the increase in prolactin other than the pituitary gland tumors, for example:

  • Some medications. There is a substance in the brain called Dopamine that works to control the amount of secretion of the milk hormone, and keep it at normal rates. Some medications prevent the effect of the Dopamine, and thus cause an increase in hormone secretion. Some of these drugs are anti psychotic medications, also gastroesophageal reflux (GER) medications such as Domeperidone or Metoclopramide.
  • Other causes include pituitary gland tumor which prevents the influence of Dopamine on the centers of the milk hormone secretion.
  • Low rates of thyroxin hormone found to be associated with the rise in milk hormone.


Diagnosis:

If a female patient suffers from an abnormal increase in the secretion of milk from the breast or has difficulties in getting pregnant or menstrual cycle disturbance, the doctor will measure the level of the prolactin in the blood. If the level is too high, it might be the cause of the illness. Then they will be an investigation for the reason of the increase through testing the levels of the thyroxin hormone, and question the patient on any medication that might cause an increase in prolactin rates. It is also important to take Radiological examination of the brain by CT scan or MRI scan, visual field tests for the vision and glaucoma screening to determine the tumor effects on the optic nerve.

Treatment:

Eighty percent of the pituitary gland tumor cases are treatable, and the chances to reduce the size of the tumor is high by decreasing the rate of prolactin through a medication called Bromocriptine  This medication should be  given gradually in small doses  to avoid side effects.

 
 

However, the medication has a partial effect in the case of high enlargement, and then the main solution is surgery. The surgery is sometimes an alternative option in case the medication is not effective and the hormone rates remain high. The surgical operation to remove the tumor is performed by Neurosurgeons by endoscopic surgery.

Pregnancy with pituitary gland tumors:

Women diagnosed with simple enlargement of the pituitary gland are capable of getting pregnant. However, the tumor will continue to grow, and there is possibility of an increase in the secretion of prolactin during pregnancy, which happens in normal pregnancy. This causes an increase in the size of pituitary gland and the secretion of the milk hormone (prolactin). This is why pregnant women need to closely monitor any changes to avoid enlargement, which has significant complications, especially on the vision.

In general, women diagnosed with pituitary gland tumor have to discuss the issue of pregnancy with their doctor before getting pregnant.  The doctor needs to make an assessment of the situation of the tumor size and levels of prolactin before pregnancy. If a woman is taking Bromucarpetn medication, she needs to stop it before becoming pregnant.


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