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Prolactinoma is a benign tumor of the pituitary gland that overproduces prolactin, a hormone primarily associated with milk production and the development of mammary glands. This excess of prolactin leads to reduced levels of sex hormones like estrogen and testosterone, potentially causing symptoms such as vision problems, infertility, and other health issues. Despite these challenges, prolactinomas are the most prevalent type of hormone-secreting pituitary tumors and are not considered life-threatening.
Prolactin, also known as lactotropin, is essential for several physiological processes beyond lactation, including the function of the immune and central nervous systems, as well as reproductive health. It is normally produced in the pituitary gland, although other parts of the body like the central nervous system, uterus, and mammary glands can also produce it. Typical prolactin levels are low in non-pregnant, non-lactating individuals, and those assigned male at birth, but are naturally higher during pregnancy and breastfeeding.
Treatment for prolactinoma usually involves medication to normalize prolactin levels and reduce the size of the tumor. In cases where medication is ineffective, surgery might be considered to remove the tumor. Managing prolactin levels is crucial as prolonged high levels, a condition known as hyperprolactinemia, can lead to significant health complications, including infertility.
Symptoms
Certain prolactinomas are specific to either males or females due to the fact that an excess of prolactin can produce hypogonadism, a disruption of the reproductive system. The sign and symptoms of prolactinoma can differ based on its size, location, and excess prolactin production.
- Females:
- A milky discharge coming from the breasts while you’re not nursing or pregnant.
- Excessive face and body hair growth and acne.
- No menstrual cycle or irregular menstruation.
- Painful sexual intercourse due to dry vagina.
- Male:
- Decreased in facial and body hair
- Enlarged breasts.
- Erectile dysfunction
- Smaller muscles
- Both female and male:
- Decrease in the pituitary gland’s production of other hormones.
- Headache
- Infertility
- Loss of interest in sexual activity
- Nausea and vomiting.
- Osteoporosis or weak bones that break easily.
- Vision problems
Premenopausal women typically become aware of signs and symptoms early, while tumors are still tiny. Missed or irregular menstrual periods are most likely responsible for this.
Postmenopausal women are more prone to experience headaches and vision issues later in life, when tumors are larger and more likely to produce symptoms. Additionally, men are more likely to detect signs and symptoms later.
Consult a healthcare provider if you notice symptoms suggestive of a prolactinoma to determine the underlying cause. If you’re planning to conceive or are already pregnant with a prolactinoma, it’s essential to discuss with a healthcare provider for potential adjustments in treatment and monitoring.
Causes
It is typically unknown what causes prolactinoma. The tumor that grows in the pituitary gland is called prolactinoma. The pituitary gland produces excessive amounts of the hormone prolactin when there is a prolactinoma. This causes a reduction in the levels of various sex hormones, specifically testosterone and estrogen.
Hyperprolactinemia, or the overproduction of prolactin, can occur for reasons other than prolactinoma. These may consist of:
- Breastfeeding or pregnancy.
- Hypoactive thyroid gland
- Kidney disease
- Medications
- Other types of pituitary tumors
Risk factors
The following risk factors for prolactinomas may include the following:
- Gender: The condition is more common to occur with female than male. The condition is rare in children and adolescent.
- Age: People under 40 are usually affected with prolactinomas.
- Others disease: Rarely, a hereditary condition such multiple endocrine neoplasia, type 1 (which results in tumors in hormone-producing glands) can increase the chance of developing a prolactinoma.
Diagnosis
If you show symptoms of a prolactinoma, your healthcare provider may recommend the following tests:
- Blood tests: These tests check for elevated prolactin levels and assess other pituitary hormones. Females of childbearing age may also undergo a pregnancy test.
- Magnetic resonance imaging (MRI) scan: This is the primary method for diagnosing a prolactinoma, using radio waves and magnets to produce detailed images of the brain.
- Computed tomography (CT) scan: If an MRI is unsuitable due to metal implants like pacemakers, a CT scan may be used to visualize the tumor.
- Testosterone test: For individuals assigned male at birth experiencing symptoms, this test checks for low testosterone levels, which can confirm a prolactinoma.
- Vision tests: If there’s a large prolactinoma, these tests determine if it’s impacting your vision.
Additionally, your provider might refer you to an endocrinologist for further evaluation and management.
Treatment
In the management of prolactinoma, the primary goals include bringing prolactin production levels back within the accepted range, reducing the size of the tumor, and restoring optimal functioning of the pituitary gland.
Treatment can help many people with a number of problems related to high prolactin levels, including irregular menstrual periods, infertility, and reduced sexual desire. It can also relieve symptoms related to tumor pressure, like headaches or blurred vision.
Prolactinoma treatment includes the following:
- Medications: Prolactinomas are commonly managed with oral medications known as dopamine agonists. These drugs mimic the role of dopamine, a neurotransmitter involved in regulating prolactin production. By using dopamine agonists, prolactin production can be lowered and tumor size can be diminished. In most cases, symptoms can be effectively alleviated with medication, which typically needs to be continued over an extended period. Cabergoline and bromocriptine are often prescribed for this purpose. Cabergoline has hardly ever caused heart valve damage in people. However, this frequently occurs in patients who are on considerably greater doses for Parkinson’s. When using these medications, some persons may experience impulse control problems like compulsive gambling. You might be able to go off a medication if it significantly decreases the tumor and your prolactin level stays within the normal range for two years. Only reduce your medication as directed by your healthcare provider. Throughout this procedure, your prolactin levels are monitored by your healthcare provider. Never stop taking your medication without first consulting with them. Once the medication is stopped, prolactin levels usually increase. In the event that this occurs, your healthcare provider will probably ask you to start taking the medication again. Your healthcare provider may start you on a very low dosage of the medication, which can frequently result in less bothersome side effects. They may then increase the dosage gradually. When taking the medication with food or right before bed, it might also be helpful.
- Medication for pregnant mother: If you are receiving treatment for prolactinoma and would like to conceive, it is advisable to talk to your healthcare provider about your options prior to becoming pregnant. Prolactinomas are treated with both cabergoline and bromocriptine. However, each medicine has a unique set of advantages and disadvantages. Talk to your healthcare provider about all the advantages and disadvantages of each of these options. You can decide which medication could be best for you together. When a pregnancy is confirmed, the healthcare provider usually suggests stopping the medication. While both medications are thought to be safe to use while pregnant, they will usually advise against using any medication at all if it is feasible. However, they could advise you to restart the medication if you have a large prolactinoma or if you experience symptoms like headaches or changes in your eyesight. By doing this, more tumor growth and problems may be avoided.
- Surgery: If medication treatment is unsuccessful or you are unable to tolerate the medication, surgery to remove a prolactinoma is typically an option. To relieve pressure on the nerves that control your eyesight, surgery might be required.
The size and extent of your tumor will determine the kind of surgery you need:- Nasal surgery/transsphenoidal surgery: This is the procedure that most commonly used to treat prolactinomas. Most patients who require surgery have the tumor removed through the nasal cavity. The procedure is carried out by a surgeon making a tiny incision beneath your upper lip or at the back of your nasal cavity.
Because the surgeon does not make contact with other parts of the brain during the procedure, the rate of complications is minimal. There are no obvious scars from this procedure. - Transcranial surgery: This treatment, also known as a craniotomy, may be necessary if your tumor is large or has spread to nearby brain tissue. The tumor is removed by the surgeon through the upper part of the head.
- Nasal surgery/transsphenoidal surgery: This is the procedure that most commonly used to treat prolactinomas. Most patients who require surgery have the tumor removed through the nasal cavity. The procedure is carried out by a surgeon making a tiny incision beneath your upper lip or at the back of your nasal cavity.
- The tumor’s size, location, and preoperative prolactin levels all affect the surgical result. Occasionally, an MRI scan reveals that a prolactinoma has spread to parts of the brain where removal attempts would be dangerous. In such cases, the prolactinoma can only be partially excised by the surgeon.
Most patients with small prolactinomas have their prolactin levels corrected by surgery. But after surgery, tumors can return in a few years. After surgery, medication therapy can frequently bring a patient’s prolactin level back into the normal range if they have larger tumors that can only be partially removed. - Radiation: If taking medicine and/or having surgery does not reduce your prolactin levels, radiation therapy is a typical third option for treating prolactinomas. In rare cases, large prolactinoma may be treated with radiation therapy to destroy the tumor cells.
High-energy X-rays or particle waves are used in radiation therapy to destroy tumor cells. You might have one radiation dose or multiple doses spread out over a few weeks, depending on the size and location of the tumor.
