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what is the best medication for pituitary gland microadenoma 6mm*6mm

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Posted on Sun, 3 Feb 2019
Question: what is the best medication for pituitary gland microadenoma 6mm*6mm just before surgery option?
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Answered by Dr. Dariush Saghafi (2 hours later)
Brief Answer:
It depends on what hormones the tumor is actually treating

Detailed Answer:
If the microadenoma is actively secreting hormones resulting in imbalance and dysequilibrium to your metabolic system to the point of causing symptoms such as dizziness, headaches, nausea/vomiting, excessive hairgrowth in places generally without hair, visual field defects, blurred vision, etc. then, PRETREATMENT with medications is warranted prior to surgical resection.

To tell you the truth I'm a bit surprised that an adenoma of this size is being resected since >90% of these tumors are benign, do not secrete hormones of consequence, and generally, are left alone since they are found incidentally to other conditions. However, if you are satisfied that your doctors have done the necessary workup and proven that the tumor is in fact, responsible for reducing your quality of life then, it should be actively treated medically. If I were in charge of the case, however, I would question the absolute need for surgical resection until seeing how well medical management proceeds.

In other words, what if your symptoms (whatever they may be) come under rapid and excellent control just by taking a small amount of medication? In that case, I would be supportive of a more "wait and see" scenario instead of going in and resecting the tumor. It's relatively small and if controlled by medicine, I'd advise that the patient continue on track with conservative management as opposed to performing a neurosurgical procedure that could result in its own unintended unwanted effects or consequences.

In the case of the prolactinoma variety of these tumors the most time tested and well known medications that can reduce the amount of prolactin being secreted are BROMOCRIPTINE and CABERGOLINE. These drugs stimulate the dopamine axis of your neurotransmitters and can help shut off the excess production of the prolactin. Another reason I usually counsel patients to try medication therapy first to see if it gives good results PRIOR to committing to surgery is because we know that the recurrence of these tumors can be as high as 50%. In some case series, lower numbers can be found down to 10%....but again, what even take the chance of doing a surgery that has ANY chance at failing if medical treatment can entirely control symptoms and hormonal levels?

If, on the other hand, the microadenoma is causing symptoms and signs of CUSHINGS SYNDROME then, I believe surgical resection is a better alternative than medication alone. If after resection of the tumor failure occurs with tumor recurrence then, the use of medications such as pasireotide (somatostatin agonist), mifepristone
(glucocorticoid receptor antagonist), or ketoconazole (adrenal steroid inhibitors) are considered and have up to a 50% success rate at shutting down the excess hormone production.

I did review other questions you posed to another doctor on this network regarding your low T levels and PROLACTINOMA secretions (i.e. excess prolactin production) does tend to lower T levels likely secondary to lowered FSH and LH levels which I believe you also mentioned you may have.

If I've provided useful information could you do me the favor of CLOSING THIS QUERY with a 5 STAR rating and positive comments?

59 minutes total time spent reviewing, researching, and analyzing the present query.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dariush Saghafi (12 hours later)
i was assuming the worst case scenario for this tumor the only problem it is causing increased prolactin levels and thus lowering Testostrone levels and i was wondering which type of meds would be best without causing other side effects?
doctor
Answered by Dr. Dariush Saghafi (5 hours later)
Brief Answer:
Meds as stated above

Detailed Answer:
Thank you for your clarification of the situation and followup question.

The relationship between elevated prolactin levels being secreted by this pituitary microadenoma and testosterone levels is to DECREASE those levels. This is not an unexpected finding with prolactin secreting tumors. However, not everyone may be testing for testosterone levels. Thyroid hormones can also be altered by eleveated prolactin levels but again, they are not commonly tested for since reducing prolactin usually brings everything else in line pretty effortlessly.

If you would refer to the 4th paragraph of my response above the medications that are most often chosen to reduce prolactin secretions from microadenomas are BROMOCRIPTINE and CABERGOLINE. What medication or medications is your doctor recommending at present, if not those?

75 minutes total time spent reviewing, researching, and analyzing the present query and its followup questions.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dariush Saghafi

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Practicing since :1988

Answered : 2474 Questions

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what is the best medication for pituitary gland microadenoma 6mm*6mm

Brief Answer: It depends on what hormones the tumor is actually treating Detailed Answer: If the microadenoma is actively secreting hormones resulting in imbalance and dysequilibrium to your metabolic system to the point of causing symptoms such as dizziness, headaches, nausea/vomiting, excessive hairgrowth in places generally without hair, visual field defects, blurred vision, etc. then, PRETREATMENT with medications is warranted prior to surgical resection. To tell you the truth I'm a bit surprised that an adenoma of this size is being resected since >90% of these tumors are benign, do not secrete hormones of consequence, and generally, are left alone since they are found incidentally to other conditions. However, if you are satisfied that your doctors have done the necessary workup and proven that the tumor is in fact, responsible for reducing your quality of life then, it should be actively treated medically. If I were in charge of the case, however, I would question the absolute need for surgical resection until seeing how well medical management proceeds. In other words, what if your symptoms (whatever they may be) come under rapid and excellent control just by taking a small amount of medication? In that case, I would be supportive of a more "wait and see" scenario instead of going in and resecting the tumor. It's relatively small and if controlled by medicine, I'd advise that the patient continue on track with conservative management as opposed to performing a neurosurgical procedure that could result in its own unintended unwanted effects or consequences. In the case of the prolactinoma variety of these tumors the most time tested and well known medications that can reduce the amount of prolactin being secreted are BROMOCRIPTINE and CABERGOLINE. These drugs stimulate the dopamine axis of your neurotransmitters and can help shut off the excess production of the prolactin. Another reason I usually counsel patients to try medication therapy first to see if it gives good results PRIOR to committing to surgery is because we know that the recurrence of these tumors can be as high as 50%. In some case series, lower numbers can be found down to 10%....but again, what even take the chance of doing a surgery that has ANY chance at failing if medical treatment can entirely control symptoms and hormonal levels? If, on the other hand, the microadenoma is causing symptoms and signs of CUSHINGS SYNDROME then, I believe surgical resection is a better alternative than medication alone. If after resection of the tumor failure occurs with tumor recurrence then, the use of medications such as pasireotide (somatostatin agonist), mifepristone (glucocorticoid receptor antagonist), or ketoconazole (adrenal steroid inhibitors) are considered and have up to a 50% success rate at shutting down the excess hormone production. I did review other questions you posed to another doctor on this network regarding your low T levels and PROLACTINOMA secretions (i.e. excess prolactin production) does tend to lower T levels likely secondary to lowered FSH and LH levels which I believe you also mentioned you may have. If I've provided useful information could you do me the favor of CLOSING THIS QUERY with a 5 STAR rating and positive comments? 59 minutes total time spent reviewing, researching, and analyzing the present query.