Dear Lactnetters,

I have a situation that I need some help with. I hope someone can help me
help this mom. TIA! Below is her history and questions. If you respond to
either the list or me personally, could you cc  Elizabeth Simeone @
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Joanne Kondak, LLLL, Port Jervis, NY
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Pregnant Female, Age 36

History:

        Diagnosed with Pituitary Macroadenoma in 1995
        Prolactin level 200+
        Treatment:  started with 2.5 mg Bromocriptine daily; in
        October 1995 was taking 10 mg daily
        Prolactin levels decline but not in normal range.
        Pituitary Macroadenoma 1.2 cm and grew to 1.4 cm by October 1995
        In October 1995, patient complained of severe headache lasting
        for days, unable to focus eyes to read, severe nausea
        Emergency surgery required to remove hemorrhaging macroadenoma

        After surgery, prolactin levels remained high (40).
        Patient discontinued  Bromocriptine after surgery.  By January
        1996, prolactin level at 70.  MRI indicated that there was no
        presence of the adenoma, however, endocrinologist surmised that
        there is a presence of prolactin-producing cells.  Patient put on
        2.5 mg Bromocriptine daily.  Prolactin levels drop within normal
        range (3-7)

        Patient became pregnant in November 1996.  Patient still
        advised to continue bromocriptine.  Prolactin levels in normal
        range throughout pregnancy (as of April 1997).

Situation:
        Patient interested in breastfeeding baby. Endocrinologist does
NOT recommend patient discontinue drug therapy since very good chance
that adenoma will regrow at a rapid rate. Conflicting information on this
drug's effect on baby while breastfeeding and virtually no information on
the effect of breastfeeding to the patient while on this drug when
the patient had a pituitary macroadenoma surgically removed in this
emergency situation.  According to the American Academy of Pediatrics, it
is not recommended to breastfeed while on bromocriptine, however other
reports (Fertil Steril) indicate that there is no effect to the baby
while breastfeeding when taking this medication.

Question:       Have there been any cases exactly as this one, that
state the mother's condition (specifically, the effects of prolactin
levels and the recurrence of the pituitary adenoma) while breastfeeding
her baby and the condition of the baby exposed to bromocriptine through
breast milk?

Question:       Is the mother more at risk for the recurrence of a
pituitary adenoma because she chose to breastfeed (assuming there are no
health risks to the baby)?

Question:       Is there a risk of a pituitary hemorrhage post partum
and, if so, what can cause this?