Prolactinomas: What Are They And How Are They Diagnosed And Treated?

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Some Information Regarding Prolactinomas

What is a prolactinoma?Prolactinomas are the most common form of pituitary gland tumor. Prolactinomas, which are non-cancerous, produce high levels of prolactin, which is a hormone that stimulates milk production (lactation) in pregnant women. Both men and women can develop prolactinomas, but they are five times more common in women than they are in men. While prolactinomas can appear at any age, including in infants, they usually form prior to age 40 in women and at a somewhat later age in men.

Prolactinomas vary in size, but most are very small (about 3/8 inch in diameter) and never grow any larger. Some prolactinomas, and particularly those that affect men, can grow to a much larger size, however.

While a person can have a prolactinoma but not suffer any noticeable symptoms, this is generally not the case. Typical symptoms seen in those who have a small prolactinoma include:

  • Milk production in women who are not pregnant or nursing
  • Changes in menstruation or stoppage of menstruation altogether (women)
  • Tenderness in the breasts (women)
  • Breast enlargement (men)
  • Reduced sexual appetite
  • Headache
  • Infertility
  • Change in vision

Symptoms seen in those who have a large prolactinoma tend to be more severe and, in addition to the above, include:

  • Severe and chronic fatigue
  • Nasal drip
  • Loss of sense of smell
  • Nausea/vomiting
  • Severe vision problems

Diagnosing And Treating Prolactinomas

Prolactinomas can be very difficult to diagnose as many of their associated symptoms are common to a host of other ailments. Therefore, prolactinomas oftentimes are diagnosed only after a long list of other diseases and disorders have been ruled out. Prolactinomas may be diagnosed merely performing an MRI scan of the cranium, or by measuring the level of prolactin in the blood (an abnormally high amount is indicative that the patient has a prolactinoma) and, if prolactin level is high, then performing an MRI scan of the cranium to confirm the presence of a prolactinoma. in males, the level of testosterone in the blood also may be measured in addition to prolactin as a first step as testosterone production is stimulated by prolactin.

In cases in which a prolactinoma is small and remains small and its symptoms are not overly oppressive, it may be recommended that it be left untreated because in such a case, treatment can be riskier no treatment. For those in need of treatment, however, there are two main options: medication or surgery to excise the prolactinoma.

Drugs that are effective for treating prolactinomas include bromocriptine and cabergoline, each one of which reduces prolaction production in both men and women. Unfortunately, if surgery is not elected, these drugs must be taken for life. As another drawback, prolonged use of bromocriptine reduces the likelihood that surgery to remove the prolactinoma will be successful if surgery is in fact later elected. Therefore, it must be decided prior to starting bromocriptine treatment whether surgery will ever be necessary or of interest.

This article is meant to provide some basic information regarding prolactinomas and how they are diagnosed and treated. if you have any further questions, and particularly if you suspect that you may have a prolactinoma, it is urged that you contact your doctor to learn more.

References

Medline Plus, National Institutes of Health, Prolactinomas: https://www.nlm.nih.gov/medlineplus/ency/article/000336.htm

National Endocrine And Metabolic Diseases Information Service, Prolactinoma: https://endocrine.niddk.nih.gov/pubs/prolact/prolact.htm