Although these medications are effective in lowering prolactin and reducing tumor size, the prolactin level may not decrease to normal (< 20). Why?
In the situation of a large tumor and very high prolactin level (several hundred, in the thousands), the medication may lower prolactin by 90%;if the level before treatment level is 10,000, a 90% reduction lowers prolactin to 1,000, certainly not normal, but a substantial reduction. The tumor size is decreased but it does not disappear. This may be acceptable if there are no other ill effects of the tumor. The most frequent hormonal problem resulting from an elevated prolactin is hypogonadism. Hypogonadism in a pre-menopausal woman results in loss of menstrual periods and difficulty becoming pregnant. Hypogonadism in men causes impotence (difficulty obtaining an erection) and infertility. Hypogonadism is treatable with hormone replacement, testosterone in men, estrogen and progesterone in women. Restoration of fertility may require additional treatments with injections of the pituitary hormones, LH and FSH.
When a tumor is large and produces a very high prolactin level (several hundred, in the thousands), the medication may lower prolactin by 90%; if the level before treatment level is 10,000, a 90% reduction lowers prolactin to 1,000, certainly not normal (normal is usually < 20), but a substantial reduction. The tumor size is decreased but it does not disappear. This may be acceptable if there are no other ill effects of the tumor such as headache or loss of vision. The most frequent hormonal problem resulting from an elevated prolactin is hypogonadism (loss of hormone production by the ovaries or testes). Hypogonadism in a pre-menopausal woman results in loss of menstrual periods and difficulty becoming pregnant. Hypogonadism in men causes impotence (difficulty obtaining an erection) and infertility. Hypogonadism is treatable with hormone replacement, testosterone in men, estrogen and progesterone in women, even if the prolactin level is reduced to normal. Restoration of fertility may
With a large tumor and very high prolactin level (several hundred, in the thousands), the medication may lower prolactin by 90%; if the level before treatment level is 10,000, a 90% reduction lowers prolactin to 1,000, certainly not normal (normal is usually < 20), but a substantial reduction. The tumor size is decreased but the tumor does not disappear. The medications do not destroy the tumor. An elevated prolactin may be acceptable if there are no other ill effects of the tumor such as headache or loss of vision. The most frequent hormonal problem resulting from an elevated prolactin is hypogonadism (loss of hormone production by the ovaries or testes). Hypogonadism in a pre-menopausal woman results in loss of menstrual periods and difficulty becoming pregnant. Hypogonadism in men causes a low blood testosterone level, loss of sexual interest, impotence (difficulty obtaining an erection) and infertility. Hypogonadism is treatable with hormone replacement, testosterone in men, estrog
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