Prolactinoma

Overview

Prolactinoma is a condition in which a noncancerous tumor (adenoma) of the pituitary gland in your brain overproduces the hormone prolactin. Its main effect is a decrease in sex hormones. Although prolactinoma is not life-threatening, it can cause problems such as vision loss and infertility.

Medication is used first to bring prolactin levels back to normal. In some special cases, surgery may also be necessary.

Symptoms

In women:

• Menstrual irregularities
• Absence of menstrual periods
• Milky discharge from the breasts, which may occur spontaneously or when the breasts are squeezed
• Painful intercourse due to vaginal dryness
• Acne, pimples, excess hair growth

In men:

• Erectile dysfunction
• Rarely, breast enlargement
• Decreased body and facial hair

In both sexes:

• Low bone mass (osteoporosis)
• Symptoms of deficiency of other hormones produced by the pituitary gland, due to pressure from the tumor
• Reduced sex drive
• Vision loss
• Infertility
• Headache

Risk factors

It is most common in women between the ages of 20 and 35. However, it can occur at any age in both sexes.

Complications

• Vision loss
• Secondary hypothyroidism and adrenal insufficiency due to pressure from the tumor
• Low bone mass (osteoporosis)

Diagnosis

It is easily diagnosed with blood hormone tests and imaging of the pituitary gland.

Treatment

The goals of treatment are:

• Bringing the prolactin hormone level back into the normal range
• Restoring the other hormonal functions of the pituitary gland
• Eliminating headaches and vision loss

Medications

Treatment uses medications called bromocriptine or cabergoline. These medications lower prolactin levels and help shrink the tumor over several months. They may have side effects such as nausea and vomiting, headache, nasal congestion, drowsiness and a drop in blood pressure when standing up. These side effects occur less often if the medication is started at a low dose and gradually increased.

If pregnancy occurs during prolactinoma treatment, the medication is usually stopped. In some cases, it may be necessary to continue it. It is advisable to discuss this with an endocrinologist.

Surgery

Surgery is performed by experienced neurosurgeons in women with a large tumor who wish to become pregnant soon, in patients with vision loss and in patients who cannot use the medication because of its side effects.