Hi there and here's the update on the possible prolactinoma case in the 6 mo
pp mom with a prolactin level of 82.3 ng/ml (2 hours after last
nursing)...The patient's HMO denied an MRI until she saw an endocrinologist.
When she saw the endocrinologist, he said "you're lactating so you are
supposed to have elevated prolactin levels." Then the patient showed him
the 2 page letter I had faxed to his office last week and the copy of the
prolactin chart from Riordan and Auerbach. He then agreed that she
definitely needed an MRI and sent her on her way. He also didn't believe
that she could squirt milk across the room and was stunned that "she was
STILL bf" and asked "how long do you plan to do that?" Her answer was "a
few more years." Great mom!
Here is my reply to her inquiry about the MRI contrast for those of you who
are following this case (this mom knows and wants me to share all the info
on this case):
Dear A: Here is the info on Gadolinium (you should print this out and bring
it with you to the MRI appt--also try to nurse C. immediately before they
inject you). Depending upon just how cautious you feel like being, you
might want to pump and dump your milk for 12-24 hours after the dye is
injected and use your stored milk. My professional opinion is that 12
hours would be being cautious with the poor oral absorption of this
mediation and the relatively short half-life of 1.6 hrs, but it really is up
to you and your family to decide. If you need help with how to get your
expressed milk into C., let me know. There are many ways to feed a baby
besides a bottle.
From Dr. Tom Hale's MEDICATIONS AND MOTHER'S MILK, 2000; P298
"Gadolinium, aka Gadoteridol, is a radiocontrast agent for MRI. Gadoteridol
is a nonionic, non-iodinated gadolinium chelate complex used as a
radiocontrast agent in MRI scans. The metabolism of gadoteridol is unknown
but a similar gadolinium salt (gadopentetate) is not metabolized at all.
The half-life is brief (1.6 hours) and the volume of distribution is very
small, suggesting that gadoteridol does not penetrate tissues well, and is
unlikely to penetrate milk in significant quanitites. A similar compound,
gadopentetate, is barely detectable in breastmilk. Although not reported,
the oral bioavailability is probably similar to gadopentetate, which is
minimal to none. ...A brief interruption of breastfeeding for 12-24 hours
should remove risk, although even that may not be necessary."
"No pediatric concerns reported via milk."
I'm going to check my schedule for Thurs to see if I can make it to your
MRI. If I can't, please know that I'll be with you in spirit.
Warmest Regards,
Chris
--Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC [log in to unmask]
€€€INFANT CUISINE AND MOTHER CARE: LACTATION CONSULTING & PERINATAL CARE€€€
Corvallis, Oregon
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