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No period for 9 months, high prolactin levels, microandenoma, hemmorhagic mass, emergency ?

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My 19 year old daughter has not had her period for over 9 months. Her GYN had her take blood tests which showed a high prolactin level (62, and 67). Her MRI results were as follows: “There is a 6mm mildly hemorrhagic pituitary mass, consistent with probable microandenoma. There is no stellar extension.” We understand microandenoma, but the “hemmorhagic” concerned us.
She is in college (3 hours away from us), and has an appointment with an endoctrinologist on April 12. I have two questions: (1) does the MRI result suggest that a medicine or surgical approach will be suggested by the doctor? If surgical, we would want to go down and be with our daughter for the initial appointment. (2) Her exams will be in three weeks. Can we cancel the April 12 appointment in her college town and wait until after the exams for her to see a doctor up where we live? We are afraid that the doctor on April 12 may inadvertently scare XXXXXXX with her diagnosis and this will affect her during exam week. Can we wait a month for this initial post-MRI appointment?
Posted Sat, 14 Apr 2012 in Brain Tumor
Answered by Dr. Robert Galamaga 23 minutes later

Thanks for your query,

It does not appear that your daughter has an emergent condition. Sometimes these slow growing adenomas can bleed a little bit. The MRI is very sensitive at picking up some of these very tiny bleeds. It is helpful in choosing an approach and depending on the means available there are some very delicate microsurgical procedures which may be an option.

I feel you can safely attend the consultation with her in 3 weeks for a thorough consideration of medical and surgical options. If she had other findings such as weakness nausea or vomiting visual disturbance or other neurological deficits then I would advise she be seen sooner.

I have adequately addressed your concern. I am available for your followups.
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Follow-up: No period for 9 months, high prolactin levels, microandenoma, hemmorhagic mass, emergency ? 3 hours later
She has had no heachaches or visual symptoms, or any of the symptoms you note. Correct me if I am wrong, but given that it is a microandenoma and their are no symptoms except for a high prolactin level, would not the most logical first step be medicine to shrink the mass? In your first paragraph, you note microsurgical procedures. Also, given the MRI results, would the endocrinologist seek any additional tests? She will have the blood work and MRI. Thanks.
Answered by Dr. Robert Galamaga 1 hour later
Thanks for your followup.

You are absolutely correct - given that this is a microadenoma, medical therapy is the usual first line. Her only real symptom is the lack of menstruation. With modern medical therapies, the size of the adenoma decreases in over 90% of patients. These medications basically bring the prolactin level down to a normal range within a few weeks at which time it is possible that in your daughter's case, her periods will resume. The endocrinologist may request an interval MRI to assess for the stability of the adenoma and may possibly assess other organ function such as the thyroid with an additional blood teat. It sounds like so far her physicians have done a prudent workup. I hope I have managed to provide you with an adequate answer. I am available for followup if needed.
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