Hi Beth,

For your client with pituitary tumor and asking about B12. Below are
several scholarly articles and the first link has other scholarly articles
to link to.

The only thing I could find re the B12 was that with growth-hormone
secreting tumors, somatostatin is often the medicine used, and one of the
side effects can be B12 deficiency. Your client seems to have
prolactin-secreting tumor, as she was on bromocriptine. I didn't find where
B12 was used to treat infertility.

I understand your client's concern with having another baby soon (history
of infant loss, and "advanced" maternal age). Has she considered bf to age
2-3 (the child may actually wean during that time?) and then pursuing her
fertility options (assisted reproduction technologies are available)? The
first link mentions other treatments but the bromocriptine seems to be the
first line treatment and often successful. The child is already 13 months
old. Some toddlers who are nursing through a pregnancy also wean due to the
decreased supply, or mother weans due to nipple discomfort or other
discomforts. So even if mother plans to bf through the pregnancy, this
might not really happen.

I am not promoting early weaning (I nursed to age 5 or 6, can't remember
exactly) but just suggesting to counsel mom on the various possible
scenarios that commonly occur with toddler nursing. I fully realize that
fertility decreases with age, and that this mother already has "one strike
against her" with the pituitary tumor, so I am not insensitive to this.

Treatment of infertility in women with pituitary tumors
http://www.ncbi.nlm.nih.gov/pubmed/17004858

Diagnosis and treatment of pituitary tumors
http://jcem.endojournals.org/content/84/11/3859.full

Laurie Wheeler RN MN IBCLC
Mississippi USA

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