Search

A 31-year-old who had a history of delayed puberty and then developed amenorrhea after stopping birth control pills was found to have a macroprolactinoma. Cabergoline therapy resulted in normalization of prolactin and menstrual periods within 6 months. The adenoma size decreased slowly, and the patient conceived. The dopamine agonist was withdrawn upon conception and restarted postpartum. Visual fields were monitored during the pregnancy which was uneventful. The diagnosis and therapy of hyperprolactinemia in a patient seeking fertility and the peri-partum management of prolactinoma during pregnancy are discussed.

An 18-year-old woman presented with galactorrhea and was thought to have a prolactinoma. As acromegaly signs and symptoms progressed, she proved to have an elevated GH nadir on oral glucose tolerance test but IGF1 was initially normal. The disease progressed and IGF-1 became elevated over time. She required two pituitary surgeries and radiation in addition to medical therapies for acromegaly. The case of discrepancy between IGF1 and GH levels is discussed as well as the management strategy for aggressive cases of acromegaly in which disease persists after pituitary surgery.

A 49-year-old man was found to have acromegaly when he was admitted to the hospital for mania, and endocrine was consulted regarding hyperglycemia. He had poorly controlled insulin-dependent diabetes. However, after his acromegaly was treated, first with surgery and then with a somatostatin analog, he was able to come off insulin with good control of diabetes. The relationship between metabolic function and growth hormone excess is discussed in the context of this case.