Prolactinoma | Complications and Treatment Options | Endocrinology

Prolactinoma

What is prolactinoma?

Prolactinoma is a non-cancerous tumor of the pituitary gland. This tumor overproduces a hormone called pituitary prolactin. The main effect of prolactinoma is a decrease in the levels of certain sex hormones: estrogen in women and testosterone in men.

Although prolactinoma is not fatal, it can cause vision problems, infertility, and other problems. Prolactinoma is a hormone-producing tumor in the pituitary gland. Sometimes the tumor grows in the pituitary gland and makes more prolactin. This type of tumor is called a prolactinoma. It is the most common type of pituitary tumor and is most often benign, which means it is not cancerous.

The new mother’s prolactin levels increase each time her baby breastfeeds. But for men or women who are not breastfeeding, high prolactin in the blood is a sign of prolactinoma. Doctors do not know what causes this, but it is very common. It occurs more often in women than in men and is very rare in children. They can often treat prolactinoma with medicine to bring your prolactin level back to normal. Surgery to remove the pituitary tumor is also an option.

Why is a prolactin levels test done?

Woman

Women with prolactinoma symptoms may need testing. Prolactinoma is a non-cancerous tumor in the pituitary gland that produces high levels of prolactin.

Symptoms of prolactinoma in women:

  • Unexplained headache
  • Vision error
  • Galactorrhea, or lactation outside of childbirth or lactation
  • Pain or discomfort during sexual intercourse.
  • Abnormal growth of body and facial hair.
  • Abnormal pimples
  • People with prolactinoma usually have tests to find out how the tumor responds to treatment.

Also, you may need a prolactin test if you have fertility problems or irregular periods. The test can also rule out other problems with the pituitary gland or hypothalamus.

Men

Men need testing if they have symptoms of prolactinoma. Symptoms of prolactinoma in men:

  • Unexplained headache
  • Vision error
  • Decreased sex drive or fertility problems.
  • Erection
  • Abnormal lack of body and facial hair

The test can also use:

  • Investigate testicular dysfunction or erection
  • Eliminate problems with the pituitary gland or hypothalamus

Symptoms of prolactinoma

The signs of prolactinoma are different in men and women. For women, the most common symptoms of a small tumor are:

  • Period of irregular structure
  • Lack of structure periods
  • Less sexual desire
  • Traumatic intercourse (caused by vaginal dryness)
  • Fertility problems
  • Breast milk is an unusual product

Since changes in the female period are evident, prolactinomas are more likely to appear early in premenopausal women. Women who have stopped menstruating can no longer have their period and do not notice symptoms when the tumor is small. When the prolactinoma is large, it can press against other nearby tissues. Symptoms include vision loss, vision changes, and headaches. When a man is diagnosed with prolactinoma, it can be large. Men are often undiagnosed when there are early signs, including:

  • Problems getting or keeping an erection
  • Decreased interest in sex
  • In rare cases, the production of breast milk.
  • Headaches or vision problems are symptoms that men often see a doctor.

Causes of prolactinoma

Prolactinoma is a type of tumor that develops in the pituitary gland. The cause of these tumors is unknown.

The pituitary gland is a small, bean-shaped gland located at the base of your brain. Despite its small size, the pituitary gland affects almost every part of your body. Its hormones help regulate important functions such as growth, metabolism, blood pressure, and reproduction.

Other causes of prolactin overproduction include medications, other types of pituitary tumors, thyroid gland dysfunction, persistent irritation of the breast, pregnancy, and breastfeeding.

Diagnosis of prolactinoma

If you have signs and symptoms that indicate you have a prolactinoma, your doctor may recommend:

  • Blood test: Blood tests can detect high levels of prolactin and other hormone levels that are regulated by the pituitary. Women of childbearing age also take a pregnancy test.
  • Mental image: Your doctor will be able to detect a pituitary tumor in an MRI image of your brain.
  • Vision tests: These will determine if the pituitary tumor is affecting your vision.

Also, your doctor may refer you for a more comprehensive examination with a doctor who specializes in treating endocrine system disorders (endocrinologist).

Prolactinoma treatment

Goals in the treatment of prolactinoma:

  • Restore prolactin production to normal levels.
  • Restore normal function of the pituitary gland
  • Shrink the pituitary tumor
  • Eliminate any signs or symptoms of tumor pressure, such as headaches or vision problems.
  • Improve Life Quality

Treatment of prolactinoma involves two main therapies: Medication and surgery.

Drugs

Oral medications often reduce prolactin production and eliminate symptoms. Medicines can also shrink the tumor. However, long-term treatment with medications is usually necessary.

Doctors use drugs called dopamine agonists to treat prolactinoma. These drugs mimic the effects of dopamine, a brain chemical that normally regulates prolactin production. Commonly prescribed medications include bromocriptine (Cycloset, Parlodel) and cabergoline. These drugs reduce prolactin production and can shrink the tumor in most people with prolactinoma.

Common side effects

Common side effects of these medications are nausea and vomiting, nasal pain, headache, and drowsiness. However, your doctor can reduce these side effects by starting with a very small dose and gradually increasing the dose.

There have been rare cases of heart valve damage with cabergoline, but it is more common in people taking high doses of Parkinson’s disease. Some people can develop compulsive behaviors such as gambling while taking these medications.

If the drug significantly shrinks the tumor and your prolactin level is normal for two years, you can lower the drug under the guidance of your doctor. However, recurrence is common. Don’t stop taking your medications without your doctor’s permission.

Medications during pregnancy

Bromocriptine is often prescribed when treating women who want to restore fertility. However, after you get pregnant, your doctor may recommend that you stop taking the medicine.

Although both drugs are considered safe in early pregnancy, their safety during pregnancy is unknown. However, if you have a large prolactinoma or have signs and symptoms such as headaches or vision changes, your doctor may recommend that you resume your medication to prevent prolactinoma complications.

If you are being treated for this disease and want to start a family, it’s a good idea to discuss your options with your doctor before you get pregnant.

Surgery

Surgery to remove the tumor is usually an option if drug treatment for this disease doesn’t work or if you can’t tolerate the drug. Surgery may be needed to reduce pressure on the nerves that control your vision. The type of surgery you undergo depends largely on the size and extent of your tumor:

  • Nasal surgery: Most people who need surgery have a procedure to remove the tumor through the nasal cavity. This is called transsphenoidal surgery. Complication rates are lower because other areas of the brain are not touched during surgery and this surgery does not leave visible scars.
  • Transcranial surgery: If your tumor is large or has spread to nearby brain tissue, you may need this procedure, also known as a craniotomy. The surgeon removes the tumor through the top of the skull.

The surgical outcome depends on the size and location of the tumor and its prolactin levels before surgery, as well as the experience of the surgeon. The higher the prolactin level, the lower the chances that prolactin production will return to normal after surgery.

Surgery corrects the prolactin level in most people with small pituitary tumors. However, many pituitary tumors come back within five years of surgery. For people with larger tumors that can only be partially removed, drug therapy often can return the prolactin level to a normal range after surgery.

Radiation

For people who don’t respond to medication and aren’t candidates for surgery, radiation therapy may be an option.

Complications of prolactinoma

Complications of prolactinoma can include:

  • Bone loss (osteoporosis): Too much prolactin reduces the production of the hormones estrogen and testosterone, which causes a decrease in bone density and an increased risk of osteoporosis.
  • Pregnancy problems: During a normal pregnancy, estrogen production increases. If you are pregnant and have a large prolactinoma, these high estrogen levels can lead to tumor growth and signs and symptoms such as headaches and vision changes.
  • Sight loss: If left untreated, it can grow as large as the optic nerve. You lose your peripheral vision.
  • Low levels of other pituitary hormones: With large prolactinomas, stress on the normal pituitary gland leads to levels of other hormones that are regulated by the pituitary, including thyroid hormones and cortisol (stress-responsive hormone).
  • If you have this disease and want to or are already pregnant, talk to your doctor. Adjustments in your treatment and supervision may be necessary.
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