Rachel, I get your question but have seen and known people (including family and friends) who were put on medication short term, long term and not at all for microprolactinomas-all depends on how "micro" it was.  Yes, Bromocriptine can be used, there are unpleasant side effects which discourage some. And i do believe it was given routinely(like candy) to moms postpartum who did not care to breastfeed (prior to 1980's?-here in US) but was discontinued due to it's side effects -some life threatening.  
I have seen low levels of pituitary hormones as well as high. Depending on where on the pituitary the hypertrophy occurs.  So it is not a growth/ tumor per se but an enlargement of the gland itself.  I had a close friend who had low milk supply with proper technique/ breastfeeding management from the get go who ended up having a macroadenoma needed surgical removal after she suddenly lost her peripheral vision!  Same with my Dad who suffered for over a year with impotence, high blood sugar ( which was attributed to his age) he almost died during a routine surgery due to a severely low thyroid level. 2 days  post op lost his peripheral vision and a macroadenoma diagnosed with immediate removal of his entire pituitary.
 I know others including clients experience low milk supply-low levels of hormones as well as high.  Correct me if I am wrong but at one of the ILCA conferences -I am not sure right now who presented but it was pointed out that prolactin levels that are too high can also result in low milk production as well.
I do believe there are cases( clients) who need further more in depth evaluation for low milk production which include lab work.  I have seen serious issues discovered either at that time or down the road.  But I also have come up against OB's who either refused the suggestion of lab work, telling the mom " some women just don't have enough milk" or order the blood work but then don't know how to properly interpret it.  So the clients always have their internist and/or endocrinologist to turn to for further investigation.  

Please know that I do not mean that everyone  who has low milk supply needs a huge work up. Putting someone through the stress, worry and anxiety of testing if not warranted should be avoided. But dismissing every case isn't appropriate either.  Even if communicating our observations and concerns to the primary physician is all we can do - it is essential.

Maria Parlapiano RN IBCLC
Chatham, NJ

Maria Parlapiano RN IBCLC

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