Prolactinomas
Prolactinomas
Prolactinomas are benign (noncancerous) tumors of the pituitary gland that produce excessive amounts of the hormone prolactin. They are the most common type of hormone-producing pituitary tumor.
Causes
- The exact cause is unknown; most prolactinomas occur sporadically without a clear genetic link.
- Certain genetic conditions can increase risk, but these are rare.
Types
- Microprolactinomas: Tumors smaller than 10 mm, more common in females (about 90%).
- Macroprolactinomas: Tumors larger than 10 mm, more common in males (about 60%) and tend to cause more symptoms due to size.
Symptoms
Symptoms result from high prolactin levels (hyperprolactinemia) and/or tumor mass effects:
In Females:
- Irregular or absent menstrual periods (amenorrhea or oligomenorrhea)
- Infertility
- Milky nipple discharge (galactorrhea) unrelated to pregnancy or breastfeeding
- Painful intercourse due to vaginal dryness
- Acne and excessive body/facial hair (in some cases)
- Early detection is common due to menstrual changes.
In Males:
- Erectile dysfunction
- Decreased libido
- Decreased body and facial hair
- Smaller muscle mass
- Enlarged breasts (gynecomastia)
- Symptoms often appear later, sometimes due to tumor pressure.
In Both Sexes:
- Infertility
- Osteopenia or osteoporosis from long-term hormone imbalance
- Loss of sexual interest
Mass Effect Symptoms (usually with macroprolactinomas):
- Headaches
- Vision problems (due to pressure on optic chiasm)
- Possible reduction in other pituitary hormones causing fatigue, low blood pressure, or low blood sugar
Diagnosis
- Blood tests showing elevated prolactin levels.
- MRI of the pituitary gland to detect and size the tumor.
- Physical exam including breast exam if galactorrhea is present.
- Evaluation of other pituitary hormones to assess function.
Treatment
- Medications: Dopamine agonists (e.g., bromocriptine, cabergoline) are first-line treatments; they reduce prolactin levels and often shrink the tumor.
- Surgery: Considered if medication is ineffective or not tolerated, or if the tumor causes significant mass effects.
- Radiation therapy: Rarely used, reserved for resistant cases.
Prognosis
- Generally good with treatment; most patients respond well to dopamine agonists.
- Early diagnosis in women often leads to better outcomes.
- Delayed diagnosis in men and postmenopausal women can lead to larger tumors and more complications.
Summary Table
| Aspect | Details |
|---|---|
| Tumor Type | Benign pituitary adenoma producing prolactin |
| Common Types | Microprolactinoma (<10 mm), Macroprolactinoma (>10 mm) |
| Key Symptoms (Women) | Irregular/no periods, galactorrhea, infertility, vaginal dryness |
| Key Symptoms (Men) | Erectile dysfunction, decreased libido, gynecomastia |
| Mass Effect Symptoms | Headache, vision problems |
| Diagnosis | Elevated serum prolactin, pituitary MRI |
| Treatment | Dopamine agonists, surgery, radiation (rare) |
| Complications | Osteoporosis, infertility, pituitary hormone deficiencies |
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References
- Cleveland Clinic: Prolactinoma – What It Is, Causes, Symptoms & Treatment1
- Mayo Clinic: Prolactinoma – Symptoms & Causes26
- Penn Medicine: Prolactinoma – Symptoms and Causes3
- Patient.info: Prolactinoma – Symptoms, Diagnosis and Treatment4
- NIDDK: Prolactinoma – Symptoms5
- NORD: Prolactinoma – Symptoms, Causes, Treatment7
- MSD Manuals: Prolactinoma – Endocrine and Metabolic Disorders8
Prolactinomas are treatable pituitary tumors causing excess prolactin production, leading to reproductive and hormonal disturbances. Early diagnosis and medical therapy typically result in good control and symptom relief.
