QUESTION: Recently I was told I have what is called empty sella syndrome. Within the past three years I developed high prolactin levels, irregular menstruation and difficulty becoming pregnant. I am 33 years old. I understand the basic pituitary problem. I wonder, though, if this has anything to do with my mild mitral valve prolapse, duodenal ulcer and spastic colon. Could the hormone disturbance from the pituitary problem cause those problems? - S.C.
ANSWER: Better back up for this one. The pituitary gland sits in a skull depression on the undersurface of the brain. That depression gets the name sella turcica (Turkish saddle) because it bears some resemblance to one, a description I accept on faith, never having seen such a saddle.In empty sella syndrome, a portion of the brain covering slips down and exerts pressure on the skull. The skull depression enlarges and the pituitary gets squashed somewhat.
More often than not, the gland continues to function normally and there are no symptoms. In some individuals, however, there will be an inordinate production of prolactin, a hormone made by the gland. That may cause a host of symptoms, including menstrual irregularities and breast milk production. Fertility can be affected. A few may have headache and blood pressure rise. However, most need no treatment. I cannot relate your mitral valve prolapse, ulcer or colon problem to this.
The Parlodel (medicine you mention elsewhere in your longer letter) is to combat the prolactin overproduction.
QUESTION: I am 34 and in my fifth month of pregnancy. I have developed carpal tunnel syndrome. Please explain. Will this go away after my pregnancy? What else besides surgery can be done for it? - S.G.
ANSWER: This is compression of the wrist (carpal) nerve passage. Many things can cause a narrowing of the tunnel, with resulting nerve pain.
It sometimes happens during pregnancy, related at least partially to extra fluid retention and swelling. The hand and fingers can hurt. Sometimes weakness develops.
Conservative methods to relieve the pain include use of splints and injection of cortisone into the area. If the condition doesn't respond to those therapies, then surgery can be done to free the tunnel space. Yes, the problem, if it is brought on by pregnancy, will subside afterwards.
QUESTION: I am taking propranolol daily to prevent my migraine headaches. Will this harm me over a long period of time? - T.F.
ANSWER: No, it won't harm you. Many people are on lifelong propranolol therapy for high blood pressure or for control of heart rhythm. I should add that propranolol (Inderal) is not for all migraines. It helps control the problem for people who have more than merely occasional migraine episodes.