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.
• 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.