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How can prolactin level be managed?

Q: My 31 years old wife had primary infertility and improper periods. Her prolactin level (PRL) was 210 ng/ml. Her MRI indicated 1.5 x 2 cm cyst and was operated for trans-sphenoidal pituitary macroadenoma successfully five years back. She gave birth to a baby the next year. Then again her periods displaced and PRL was found 57.1 ng/ml. MRI was done and 1.1 x 0.7 cm sized peripherally enhanced cyst in the right half of the sella and thin enhancing soft tissue evolving the ICA in its left half (recurrent lesion) was found. So, she started taking Cabergoline 0.5mg 1 tablet per week. Now the levels are below 11 ng/ml since then. For how long she would be talking this medicine? Because the moment she stops taking medicine her PRL increases. Is there any side effect of the medicine if she continues taking it for life long? What else we can do to reduce PRL? Will size of the tumour remain same if medicine is taken? What could be the implication of this when menopause occurs? Can we go for second baby?

A:Since she has pituitary macroadenoma in which the level was 210 to start with, she needed surgery with regular follow up. Now her levels are such that she can be treated with medicines alone. She will have to take these medicines till the level comes down to normal. These medicines can be taken for a long duration also without any significant side effect. Even after the levels come down to normal, she will need regular follow up and if level increases, she might have to restart the treatment again.

Usually macroadenoma respond very well to medical management and do not increase in size but need regular follow up.

You can plan your pregnancy but before planning you will have to be switched over from Cabgolin to Bromocriptin, which can be safely continued in pregnancy.

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