Prolactinoma

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Prolactinoma is a condition in which pituitary adenoma produces too much hormone called prolactin in the body. Prolactinoma is the most common type( 25-30%) of all pituitary tumor .

What is the pathophysiology of Prolactinoma?

Adenoma is due to neoplastic change of pituitary lactotrophs , results in excess production and secretion of hormone prolactin.

What is the signs and symptoms of Prolactinoma?

Signs and symptoms is caused by secondary to the excess hormone production and to the space occupying effect by the tumor .

Symptoms in women :

1. Galactorrhea( Abnormal milk flow form the breast of non pregnant or non breast feeding women)
2. Decreased sexual desire
3. Infertility
4. Irregular menstrual periods ( oligomenorrhea to amenorrhea)
5. Dyspareunia( painful sexual intercourse)
6. Breast tenderness
7. Fracture of bones

Symptoms in Men :

1. Gynecomastia( enlarged breast )
2. Decreased sexual desire
3. Impotence ( Inability of the male to achieve of maintain an erection of sufficient rigidity to perform sexual intercourse successfully)
4. Decreased body hair
5. Small testis

Symptoms due to space occupying lesion :

1. Headache
2. Nausea and vomiting
3. Nasal drainage
4. Visual disturbance
5. Double vision
6. Problems in smelling
7. Lethargy

How is a Prolactinoma diagnosed ?

Diagnosis relies on clinical findings , Laboratory tests and radiological imaging .

1. Laboratory tests shows increased serum prolactin levels with decreased testosterone levels in men . TSH levels is needed to exclude the possibility of an increased prolactin level secondary to increased TRH level.
2. Radiological imaging which includes CT and MRI shows pituitary mass.

How is a Prolactinoma managed?

Medication is usually sufficient in treating prolactinoma but surgery is needed in some cases who have the vision problem.

1. Bromocriptine (BEC) is a choice of drugs in the treatment of prolactionma with the doses of 1.25 mg nighty with food initially and is gradually increased to 2.5 mg two times a day in 1-2 weeks.
2. Carbergloine a long acting dopamine agonist is used for the patients who do not respond to bromocriptine.
3. Surgery is indicated when drug therapy doesn’t work or have the symptoms of mass occupying lesion . Sugery includes Transsphenoidal or Transcranial removal or pituitary tumor.
4. Radiotherapy is usually reserved for those whose prolactinoma that gets worse after both medication and surgery.

What is the prognosis of Prolactinoma ?

Prognosis depends upon the response of medical therapy or surgery.

References:

• http://www.emedicinehealth.com
• http://www.mayoclinic.com
• http://en.wikipedia.org
• http://www.medicinenet.com
• http://www.ncbi.nlm.nih.gov
• Harrison’s Principles of Internal Medicine, 17^th edition.
• Davidson’s Principles and Practice of Medicine, 20th Edition
• Sabiston textbook of surgery 18th edition

Filed Under: Endocrine

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