Not all pituitary tumors are cause for alarm

Ask Dr. Keith Roach M.D

Not all pituitary tumors are cause for alarm

DEAR DR. ROACH: My wife has been told that she has a tumor (noncancerous, the doctors think) on her pituitary gland. The specialist told her that it's so small that they don't expect it to grow, and since she isn't showing any symptoms, they are not going to do anything about it. He told her to get another MRI in a year to see if the size has changed. It was very small (microadenoma). It was found when she was noted to have a high amount of prolactin.

This scares me. The pituitary gland is important to several functions of the human body, hormonewise. A tumor on or near it should be removed, in my (non-medically trained, of course) opinion.

Should she get a second opinion on this tumor and any kind of treatment plan? And what is your opinion on pituitary gland tumors? Remove them or not? — A.A.

ANSWER: Pituitary tumors are much more common than once thought. They can be found when a person produces too much hormone, such as TSH, the hormone that stimulates the thyroid to produce thyroid hormone, or if a person doesn't produce the hormones he or she is supposed to, causing low thyroid hormone or other deficiencies — especially low LH (luteinizing hormone) and FSH (follicle-stimulating hormone), which regulate ovarian function and the menstrual cycle in women. Any pituitary tumor, even if it doesn't make anything, can cause a high prolactin level, since a tumor can block the signal telling the pituitary NOT to make prolactin. Prolactin stimulates milk production after a woman has a baby, but very high levels can cause galactorrhea (milk production) in a woman who hasn't been pregnant. Prolactin-producing tumors have higher prolactin levels. The diagnosis of a pituitary tumor is made by carefully evaluating the hormone regulation and by imaging the pituitary gland, usually with an MRI.

Pituitary tumors are treated if they are causing significant problems. The optic nerve runs right underneath the pituitary gland, so a large tumor can affect eyesight, and this situation needs prompt treatment.

A microadenoma is less than 1 cm, and 95 percent of these did not enlarge in a study following people for four to six years. Prolactin-secreting tumors can be treated medically — and they should be if the LH and FSH are affected — by a medicine such as cabergoline. Cabergoline also can be used if the prolactin level is high enough to cause galactorrhea.

I understand the desire to remove a tumor in such an important area. It is a universal human response. However, not all require surgery, or even treatment with medication. Surgery is indicated to relieve vision changes or other neurologic problems related to the tumor, which isn't likely in your wife's case because it is small, or to manage hormone deficiencies. One deficiency your wife's endocrinologist would have evaluated carefully is the ability to make cortisone. If the pituitary can't make enough cortisone (this happens about 30 percent of the time), that requires prompt treatment.

DEAR DR. ROACH: I was diagnosed with fatty liver. Can you please tell me if this can be reversed, or if it is progressive? — M.K.

ANSWER: Fatty liver can have many causes, but it is much more common in people who are overweight or have diabetes (or both). Weight loss (even modest loss) and good control of diabetes can help reverse it. Alcohol use is another big cause, and abstinence is recommended for those with fatty liver. Fatty liver should be followed to see if it progresses to liver fibrosis.