Rachel,

Yes, I agree.  Technically her supply SHOULD be abundant, but in this case, well, that is not the case.  From what I could surmise from my reading is that there is very little information (that I could find) re: prolactinomas and breastfeeding.  

 One article stated "Breastfeeding is safe and has not been associated with the growth of underlying prolactinomas". And, that was the only mention of breastfeeding I could find!  One would think there would be more discussion about the relationship between a pituitary tumor, hyperprolactinemia ( prior to pregnancy) and breastfeeding, even if there aren't documented cases of breastfeeding problems, per se. Hm...

It does appear that the hormonal interactions are so complex and we still have much to learn about those interactions and complexities.  Take PCOS.  Why do many women have hypoplasia and/or milk supply issues, and others have no issues whatsoever, and even an oversupply?  We understand a lot about those interactions, but not entirely.
 
The same article stated "A pregnancy induced with a dopamine agonist appears to run a benign course in terms of tumor growth. More interesting is the fact that there is often improvement or resolution of hyperprolactinemia (50-72%) and prolactinoma regression or disappearance following the pregnancy. Crosignani observed a 29% resolution,[16] and Badawy noted a 27% reduction or disappearance of tumor after delivery.[17] Idiopathic hyperprolactinemia cases were even more likely to resolve following pregnancy. The author has had a similar clinical observation. The mechanism of resolution is unknown, but there is speculation regarding vascular ischemia and necrosis in tumor tissue. This does not explain the greater resolution in nontumorous (idiopathic) cases."  

http://emedicine.medscape.com/article/127650-overview#aw2aab6b3

So, maybe if there was a regression in her tumor size (which we would not know b/c it appears hormones have not been checked or follow up with her endocrinologist for quite some time), that could play a role in all of this?  And, I agree.  It is very possible her issues have absolutely nothing to do with the prolactinoma.  There could have been subtle latch issues, mom could have an undiagnosed thyroid issue, she may not have been BF or pumping enough, she supplemented early on, etc...  And, because I could not observe the BF dyad in person and now she is no longer BF, I will never have some of these answers.  But, even if this particular mom decides not to pursue finding a cause for her low milk supply, or go back to her endocrinologist for further testing, I would like to know if there is any information out there. Maybe there is not, b/c maybe, as Rachel said, this issue should be associated with OVERSUPPLY, not UNDER.

In response to your question, mom has not taken bromocriptine for about 4 years, prior to becoming pregnant with her first child.  She also has not had an MRI since then.  She did not undergo any surgery.  She has not received treatment for her prolactinoma since then to my knowledge.  She did go through infertility treatment, in conjunction with acupuncture to get pregnant, which apparently regulated her cycles.

Thanks again for the responses!  Happy New Year to all!

Nina Isaac

> Date:    Sat, 31 Dec 2011 11:30:36 +0100
> From:    Rachel Myr <[log in to unmask]>
> Subject: Microprolactinoma
> 
> I am wondering if I have missed something here, since no one has
> mentioned it.  Maybe there are new theories on what prolactin does in
> the body and I haven't heard of them.  At the risk of looking foolish
> I will post anyway.
> 
> Wouldn't a prolactin-secreting tumor cause massive OVERSUPPLY?   How
> is the prolactinoma being treated?  The standard treatment used to be
> bromocriptine, and if this mother has been given bromocriptine, or is
> taking it regularly, then all the fenugreek in town isn't going to
> make much of a dent.   I don't know what, if any, surgical techniques
> are available, but if her prolactin-secreting pituitary cells have
> been tampered with, it's not exactly earth-shaking sensational news
> that milk supply is low.
> 
> I haven't followed anyone with this diagnosis but my first question to
> anyone contacting me would be 'and how is your tumor being treated?'
> She got pregnant somehow, so either it is a brand new tumor or was
> already treated before the pregnancy.  Prolactinomas cause menstrual
> irregularities, remember?
> 
> She may not even know that the medication to treat the tumor is going
> to jeopardize breastfeeding, and, incredible as it may seem, the
> endocrinologist treating her (there is almost certainly an
> endocrinologist already involved since she has been diagnosed,
> according to the original post) may not have thought to a) talk with
> her about her plans for breastfeeding or b) inform her that the
> medication has been used to suppress lactation.
> 
> Rachel Myr
> Wishing you all a happy new year from Kristiansand, Norway
> 
>             ***********************************************


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