Prolactinoma

Description

Prolactinoma is a noncancerous tumor of the pituitary gland. This tumor causes the pituitary gland to produce too much of a hormone called prolactin. The main effect of a prolactinoma is the decrease of the levels of some sex hormones — namely estrogen and testosterone.

A prolactinoma is not life-threatening. But it can cause difficulty in vision, infertility, and other problems. Prolactinoma is the most common type of hormone-producing tumor that can develop in the pituitary gland.

A prolactinoma can usually be treated with medications to bring the prolactin levels down in the standard range and reduce the size of the tumor. In some cases, surgery to remove the tumor may be an option.

Symptoms

A prolactinoma may not cause any signs or symptoms. However, the excess of prolactin in the blood (hyperprolactinemia) can cause symptoms. So can the pressure on the surrounding tissues of a large tumor.

Because the excess prolactin can affect the reproductive system (hypogonadism), some of the signs and symptoms of prolactinoma are specific to women or men.

In females, prolactinomas can cause:

  • Irregular menstrual periods or lack of menstrual periods
  • Milky discharge from the breasts when you're not pregnant or breastfeeding
  • Pain during intercourse due to vaginal dryness
  • Acne and excess facial and body hair growth

In males, prolactinomas can cause:

  • Erectile dysfunction
  • Decreased facial and body hair
  • Smaller muscles.
  • Enlarged breasts

In both, women and men, prolactinoma can cause:

  • Infertility
  • Weak and brittle bones that break easily (osteoporosis)
  • Loss of interest in sexual activity

The pressure of growth of the tumor can cause:

  • Vision problems
  • Headache
  • Reduction of other hormones produced by the pituitary gland

Women who are premenopausal tend to notice signs and symptoms in the early stages, when the tumors are smaller in size. This is probably due to the missed or irregular menstrual periods. Postmenopausal women are more likely to notice the signs and symptoms later, when the tumors are larger and are more likely to cause headache, or vision problems. Men are also more likely to notice the signs and symptoms later.

When to see a doctor

If they develop signs and symptoms that may be caused by a prolactinoma, consult your health care provider to determine the cause.

If you have a prolactinoma and want to become or are already pregnant, talk with your health care provider. Adjustments in your treatment and follow-up may be necessary.

Causes

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

The pituitary gland is a small, bean-shaped gland located at the base of your brain. Despite its small size, the pituitary gland has an effect on almost every part of your body. Your hormones help to control important functions such as growth, metabolism, blood pressure and reproduction.

A prolactinoma causes the pituitary gland to produce too much of a hormone called prolactin. This results in a decrease in the level of some sex hormones — namely estrogen and testosterone.

Making too much prolactin (hyperprolactinaemia) can also occur for reasons other than a prolactinoma. These may include:

  • Drugs
  • Other types of tumors of the pituitary gland
  • Kidney disease
  • Hypofunction of the thyroid gland
  • Pregnancy and lactation

Risk factors

Most prolactinomas occur in women than in men. The disorder is uncommon in children.

Rarely, an inherited disorder such as multiple endocrine neoplasia type 1 — a disorder that causes tumors in the glands that produce hormones — can increase the risk of a prolactinoma.

Complications

Complications of prolactinomas may include:

  • The infertility. A prolactinoma can interfere with reproduction. Too much prolactin reduces the production of hormones such as estrogen and testosterone. Too much prolactin can also prevent the release of an egg during the menstrual cycle (anovulation) in females. In men, excess prolactin may also lead to the decrease in the production of sperm.
  • The loss of bone (osteoporosis). Decline in estrogen and testosterone can also cause decreased bone strength. This results in the weakness and fragility of the bones that can break easily.
  • Complications in pregnancy. During a typical pregnancy, the production of estrogen increases. This can cause the growth of the tumor. This can cause signs and symptoms such as headaches and changes in vision in pregnant women who have large prolactinomas.
  • The loss of vision. Left untreated, a prolactinoma can grow large enough to put pressure on the optic nerve. This nerve is located near the pituitary gland. The nerve sends images from the eye to the brain, so that you can see. The first sign of pressure on the optic nerve is a loss of side (peripheral) vision.
  • Low levels of other hormones of the pituitary gland. More large prolactinomas can put pressure on the healthy part of the pituitary gland. This can lead to the decrease of the levels of other hormones controlled by the pituitary gland. These include the thyroid hormones and cortisol. Cortisol is a stress response hormone.

Prolactinoma

Diagnosis

If you have signs and symptoms that suggest that you have a prolactinoma, your health care provider may recommend:

  • Blood tests. Blood tests can show if the excess prolactin is being made. They can also show whether the levels of other hormones controlled by the pituitary gland are within the standard range. A pregnancy test is usually recommended for women of childbearing age.
  • The brain images. Your doctor may be able to detect a prolactinoma the use of a magnetic resonance image (MRI) of the brain.
  • Vision tests. These can determine if a prolactinoma is affecting his eyesight.

Your provider may also refer you for additional testing with a specialist in the treatment of disorders that affect the endocrine glands and the hormones (endocrine).

Treatment

Goals in the treatment of a prolactinoma, which include:

  • Return of the production of prolactin within the standard range
  • Reduce the size of the prolactinoma
  • Restore healthy function of the pituitary gland

For most people, treatment can eliminate or improve:

  • The problems caused by the increase of prolactin levels, such as irregular menstrual periods, infertility, and loss of interest in sexual activity
  • Signs or symptoms of tumor of pressure, such as headaches or vision problems

Prolactinoma treatment includes two main therapies: medications and surgery.

Drugs

Oral medicines known as dopamine agonists are generally used to treat prolactinoma. These drugs mimic the effects of dopamine in the brain chemical that controls the amount of prolactin is done. Dopamine agonists can decrease the production of prolactin and reduce the size of the tumor. The drug can eliminate the symptoms of most people with prolactinomas. However, in general, the need for long-term treatment with medications.

Commonly prescribed drugs include cabergoline and bromocriptine (Cycloset, Parlodel).

If a drug that reduces the tumor and significantly their levels of prolactin were maintained within the standard range of two years, you may be able to decrease the consumption of drugs. Only reduce your medications with your health care provider for guidance. Your provider monitors the levels of prolactin during this process. Do not stop taking your medicine without first talking with your healthcare provider.

Prolactin levels are commonly elevated after stopping the medication. If this occurs, your doctor will probably ask you to restart to take the medication.

Common side effects of the medications

The common side effects of these drugs include nausea and vomiting, dizziness, nasal congestion, and headache. However, these side effects can often be less annoying if your health care provider will start with a very low dose of the drug. Then, your doctor may gradually increase the dose. It can also help if you are taking the medication with food or if it is taken at bedtime.

People have rarely had a damaged heart valve with cabergoline. But usually people take much higher doses for Parkinson's disease. Some people may develop impulse control disorders such as pathological gambling, while taking these medications.

Medication during pregnancy

Both bromocriptine and cabergoline in the treatment of prolactinomas in people who want to become pregnant. But the drugs have different advantages and disadvantages. Discuss the pros and cons of these options with your health care provider. Together you can decide which drug may work better for you.

In most situations, a provider typically it is advised to stop the drug when the pregnancy was confirmed. Although both drugs are considered safe during pregnancy, your doctor will generally recommend avoiding any type of medication during pregnancy whenever possible. However, if you have a large prolactinoma or develop signs and symptoms such as headaches or changes in vision, your doctor may recommend that you restart the drug. This prevents the growth of the tumor and complications.

If you are being treated for prolactinoma and you would like to start a family, it is best to discuss your options with your doctor before you become pregnant.

Surgery

Surgery to remove a prolactinoma is usually an option if the drug therapy is not working or can't tolerate the medication. Surgery may be needed to relieve the pressure on the nerves that control vision.

The type of surgery you have will depend largely on the size and extent of the tumor:

  • The Nasal surgery. To the majority of people who need surgery, the procedure involves the removal of the tumor through the nose (nasal cavity). This surgery is called a surgery transsphenoidal. Complication rates are low because the surgeon does not touch other areas of the brain during surgery. This surgery leaves scars visible.
  • Transcranial surgery. If the tumor is large or has spread to nearby tissues of the brain, you may need this procedure, also known as a craniotomy. The surgeon removes the tumor through the top of the skull.

Results of surgery will depend on the size and location of the tumor and the levels of prolactin before the surgery. The skill of the surgeon and the experience with this type of surgery is also a factor. Sometimes an mri shows that a prolactinoma has been extended to areas in the brain, where it is dangerous to attempt removal. When this happens, the surgeon can only partially remove the prolactinoma.

The surgery corrects the levels of prolactin in the majority of individuals with small prolactinomas. However, tumors can reappear within several years of the surgery. For people with larger tumors that can only be partially removed, the drug therapy can often return prolactin levels to the standard range after surgery.

Radiation

Rarely, radiation therapy to kill tumor cells may be an option for a large prolactinoma. You may have radiation if you do not respond to the medication, if you are not able to undergo surgery, or if surgery is not to eliminate all of a large tumor.

Preparing for your appointment

It is likely to start by seeing your family doctor. Then, you may be referred to a specialist in disorders that affect the endocrine glands and the hormones (endocrine).

Here's some information to help you prepare for your appointment.

What you can do

Before your appointment, you can make a list of:

  • Your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment
  • Your menstrual history, including the age of onset of the periods, the episodes of absence of menstrual periods, dates and type of contraceptive used
  • Key personal information, including major stresses or recent life changes
  • All the drugs, vitamins, herbs, and supplements you are taking and the dose
  • Questions for your doctor

Basic questions to ask may include:

  • What is the most likely cause of my symptoms?
  • What are other possible causes?
  • What tests do I need? Do not require special preparation?
  • What treatments are available, and which do you recommend?
  • What side effects can I expect from treatment?
  • If I have the surgery, the prolactinoma back?
  • I have other health conditions. How can I best manage them together?
  • I'm going to be able to have children?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there brochures or other printed material that I can take? What sites do you recommend?

Don't hesitate to ask any other questions during your appointment.

What to expect from your doctor

Your provider is likely to ask questions such as:

  • When did your symptoms begin?
  • The symptoms been continuous or occasional?
  • Nothing seems to improve the symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Have you or members of the family had high calcium levels, kidney stones, or tumors in the endocrine glands?

The preparation to respond to the questions can help you make the most of your appointment time.

Symptoms and treatment of Prolactinoma