Does a patient with prolactinoma require cortisol before undergoing pituitary surgery?
Patient's Query
Hello doctor,
I would appreciate your opinion about a case in which pituitary surgery has been indicated. A patient in his early 70s was diagnosed with a prolactinoma ten years ago. He was prescribed a tablet of Dostinex 0.5 mg per week, which was then reduced to 0.5 mg per two weeks. The prolactin levels went down, but tumor size was slowly increasing. He was evaluated this month, but his prolactin levels are still low, and the optic chiasma compression affects the visual fields. I would like to know if we can assume that his adenoma is drug-resistant even though the maximum dosage reported in the literature is 3.5 mg of Cabergoline per week. As his prolactin levels are low, will the tumor shrink on increasing the dose? The patient took a tablet of Sotalol and had a history of Wolf-Parkinson-White syndrome.
Thank you.
Hello,
Welcome to icliniq.com
Pituitary surgery is rarely required in prolactinomas and is generally reserved for patients intolerant or resistant to Dopamine agonist therapy, Cabergoline. Surgery is indicated only if visual field defects, headaches, and hypopituitarism are present. In addition, the tumor is resistant to the drug, so there will not be any benefit in increasing the drug dose.
Patient's Query
Thank you doctor for the reply,
I would like to know if Cortisol is required before surgery, as they usually inject Hydrocortisone right before surgery, and dosage might depend on initial levels.
Thank you.
Hello,
Welcome back to icliniq.com
It depends on the decision of your endocrine surgery team. Unfortunately, I am unaware of the patient's adrenocorticotropic hormone (ACTH) and other pituitary hormone levels, so I might not be in a better position to judge the cortisol requirements at this point.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
Related Questions
All my reports are normal but I still have gynecomastia. What could be the reason?
I have high prolactin.Will this affect my fertility?
Could you advise a possible treatment for my sleep problem?
What are the recommended procedures to reach brain by a neurosurgeon?
Is treatment possible for pituitary macroadenoma with Cabergoline alone?
Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.