Neurologic & Orthopedic Hospital Blog — Drs. Cerullo & Sheinkop, Chicago

Complicated Treament Decisions

Speaking of decisions. I saw a young lady today, about 30 years old. She was diagnosed with a pituitary tumor about five years ago during an evaluation for lactating breasts and irregular menstrual periods. Luckily, the tumor was small and of the type which could be treated with oral medications. She began taking the pills, which she tolerated well. Her periods became regular, and she stopped the treatments. She had no desire to become pregnant at the time. Her symptoms (irregular menses and galactorrhea) recurred, so she resumed the medication. Now, four years later, she remains free from symptoms on treatment but desires pregnancy. She has the option of continuing the medication while becoming pregnant or undergoing surgery. She was told there are small risks to the fetus if she becomes pregnant while taking the medicine for her tumor. On the other hand, there are risks of surgery, including the loss of pituitary gland function, which would require her to take other medicines (with their own risks) to conceive.

In addition, her tumor may be growing in spite of the medicine, which must now be given at a higher dose to control the tumor. What is the answer? If the higher dose of drug controls the tumor, she will be back to square one. If not, she must consider radiation therapy or surgery to protect her normal gland as well as her optic (visual) nerves which are very close to the pituitary gland and tumor. Either of these treatments runs a small risk of loss of pituitary function with the need for replacement hormone medications in addition to the general risks of surgery. What would be your choice? Note: There are no right or wrong answers.

The Neurologic & Orthopedic Hospital Blog was created to provide insightful brain, back, and joint information to people that struggle to find the right path in the maze of healthcare-related decisions they face today. The power of the internet is transforming health information and empowering people to take a front seat in managing their own health; correspondingly it has inspired Doctors Leonard Cerullo and Mitchell Sheinkop to share NOHC's cutting-edge resources with the online community.

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