{"id":4422266,"date":"2025-01-11T11:33:55","date_gmt":"2025-01-11T17:33:55","guid":{"rendered":"https:\/\/myendoconsult.com\/learn\/topics\/prolactinoma\/"},"modified":"2025-01-13T06:51:51","modified_gmt":"2025-01-13T12:51:51","slug":"prolactinoma","status":"publish","type":"oen_topic","link":"https:\/\/myendoconsult.com\/learn\/topics\/prolactinoma\/","title":{"rendered":"Prolactinoma"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">PROLACTIN-SECRETING PITUITARY TUMOR<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Definition and Pathophysiology<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Prolactinomas<\/strong>: Prolactin-secreting pituitary tumors (<a href=\"https:\/\/myendoconsult.com\/learn\/prolactinoma\/\" data-type=\"link\" data-id=\"https:\/\/myendoconsult.com\/learn\/prolactinoma\/\">prolactinomas<\/a>) are the most common hormone-secreting pituitary tumor.<\/li>\n\n\n\n<li><strong>Cell Origin<\/strong>: Monoclonal lactotroph cell adenomas, typically resulting from sporadic mutations.<\/li>\n\n\n\n<li><strong>Association With MEN1<\/strong>: Although most prolactinomas are sporadic, they are the most frequent pituitary tumor in persons with multiple endocrine neoplasia type 1 (MEN1).<\/li>\n\n\n\n<li><strong>Benign Nature<\/strong>: More than 99% of prolactinomas are benign.<\/li>\n\n\n\n<li><strong>Co-secretion<\/strong>: Approximately 10% of prolactin-secreting pituitary tumors also secrete growth hormone (GH) due to a somatotroph or mammosomatotroph component.<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">CLINICAL PRESENTATION<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Presentation in Women<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Prolactin-secreting Microadenomas (\u226410 mm)<\/strong>\n<ul class=\"wp-block-list\">\n<li>Typical presentation: Secondary amenorrhea, with or without galactorrhea.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Presentation in Men and Postmenopausal Women<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Late Diagnosis<\/strong>\n<ul class=\"wp-block-list\">\n<li>Small <a href=\"https:\/\/myendoconsult.com\/learn\/what-is-a-prolactinoma\/\" data-type=\"link\" data-id=\"https:\/\/myendoconsult.com\/learn\/what-is-a-prolactinoma\/\">prolactinomas<\/a> often go undetected due to lack of symptoms.<\/li>\n\n\n\n<li>Diagnosis is typically delayed until the adenoma enlarges and causes mass-effect symptoms.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Mass-Effect Symptoms of Macroadenomas<\/strong>\n<ul class=\"wp-block-list\">\n<li>Visual field defects (due to suprasellar extension)<\/li>\n\n\n\n<li>Cranial nerve palsies with lateral (cavernous sinus) extension (e.g., diplopia, ptosis)<\/li>\n\n\n\n<li>Headaches<\/li>\n\n\n\n<li>Hypopituitarism due to compression of normal pituitary tissue<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Effects of Hyperprolactinemia<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Decreased Gonadotropin Secretion<\/strong> (both men and women)<\/li>\n\n\n\n<li><strong>In Men<\/strong>:\n<ul class=\"wp-block-list\">\n<li>Hypogonadotropic hypogonadism \u2192 testicular atrophy, low serum testosterone, decreased libido, sexual dysfunction, decreased facial hair growth, decreased muscle mass<\/li>\n\n\n\n<li>Galactorrhea is rare (lack of estrogen needed to prepare breast tissue)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>In Premenopausal Women<\/strong>:\n<ul class=\"wp-block-list\">\n<li>Bilateral spontaneous or expressible galactorrhea<\/li>\n\n\n\n<li>Secondary amenorrhea and estrogen deficiency symptoms (e.g., hot flashes, vaginal dryness)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Long-Standing Hypogonadism (Men and Women)<\/strong>:\n<ul class=\"wp-block-list\">\n<li>Osteopenia and osteoporosis<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">SERUM PROLACTIN CONCENTRATION AND TUMOR SIZE<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Prolactin Levels Generally Proportional to Adenoma Size<\/strong>\n<ul class=\"wp-block-list\">\n<li>Microadenoma (~5 mm): Serum prolactin usually 50\u2013250 ng\/mL (reference range, 4\u201330 ng\/mL).<\/li>\n\n\n\n<li>Macroadenoma (>2 cm): Serum prolactin often >1000 ng\/mL.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Exceptions<\/strong>\n<ul class=\"wp-block-list\">\n<li>Small adenomas with very high secretory capacity (>1000 ng\/mL).<\/li>\n\n\n\n<li>Large adenomas (macroadenomas) with inefficient secretion (&lt;200 ng\/mL).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">TREATMENT CONSIDERATIONS<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Indications for Treatment<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Guided by<\/strong>:\n<ol class=\"wp-block-list\">\n<li>Symptoms related to hyperprolactinemia<\/li>\n\n\n\n<li>Mass-effect symptoms from the sellar mass<\/li>\n<\/ol>\n<\/li>\n\n\n\n<li><strong>Examples<\/strong>:\n<ul class=\"wp-block-list\">\n<li>A small microadenoma (4 mm) in an asymptomatic postmenopausal woman may be observed without treatment.<\/li>\n\n\n\n<li>Macroadenomas generally warrant treatment due to their tendency to grow over time and cause mass effects.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Mainstay of Therapy: Dopamine Agonists<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>When Treatment Is Indicated<\/strong>\n<ul class=\"wp-block-list\">\n<li>E.g., presence of secondary hypogonadism (in men or premenopausal women) or a macroadenoma.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Orally Administered Dopamine Agonists<\/strong>\n<ul class=\"wp-block-list\">\n<li>Cabergoline or <a href=\"https:\/\/myendoconsult.com\/learn\/how-does-bromocriptine-work-in-prolactinoma\/\" data-type=\"link\" data-id=\"https:\/\/myendoconsult.com\/learn\/how-does-bromocriptine-work-in-prolactinoma\/\">bromocriptine<\/a><\/li>\n\n\n\n<li>First-line choice for prolactinomas<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Effects of Dopamine Agonists<\/strong>\n<ul class=\"wp-block-list\">\n<li>Rapid normalization of serum prolactin levels<\/li>\n\n\n\n<li>Reduction in the size of the lactotroph adenoma<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Monitoring and Dosage Adjustment<\/h4>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Serum Prolactin Concentration<\/strong>\n<ul class=\"wp-block-list\">\n<li>Check every 2 weeks after starting therapy.<\/li>\n\n\n\n<li>Adjust dose of bromocriptine or cabergoline until prolactin normalizes.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Imaging<\/strong>\n<ul class=\"wp-block-list\">\n<li>Repeat <a href=\"https:\/\/myendoconsult.com\/learn\/prolactinoma-mri\/\" data-type=\"link\" data-id=\"https:\/\/myendoconsult.com\/learn\/prolactinoma-mri\/\">pituitary MRI<\/a> ~3 to 6 months after achieving normal prolactin levels to confirm tumor shrinkage.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Maintenance<\/strong>\n<ul class=\"wp-block-list\">\n<li>Continue the minimal effective dose indefinitely.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n\n\n\n<h4 class=\"wp-block-heading\">Potential \u201cCure\u201d<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Long-Term Dopamine Agonist Therapy<\/strong>\n<ul class=\"wp-block-list\">\n<li>Rarely, prolactin-secreting adenomas may be cured.<\/li>\n\n\n\n<li>Periodic (e.g., every 2 years) 2-month \u201cdrug holiday\u201d is recommended to see if hyperprolactinemia recurs.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Special Considerations<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Sphenoid Sinus Extension<\/strong>\n<ul class=\"wp-block-list\">\n<li>Risk of cerebrospinal fluid (CSF) rhinorrhea with tumor shrinkage.<\/li>\n\n\n\n<li>CSF rhinorrhea requires urgent neurosurgical intervention to prevent pneumocephalus and bacterial meningitis.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Intolerance or Resistance to Dopamine Agonists<\/strong>\n<ul class=\"wp-block-list\">\n<li>Symptoms: Nausea, lightheadedness, mental fogginess, vivid dreams.<\/li>\n\n\n\n<li>Alternative Options: Transsphenoidal surgery or Gamma Knife radiation therapy.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>PROLACTIN-SECRETING PITUITARY TUMOR Definition and Pathophysiology CLINICAL PRESENTATION Presentation in Women Presentation in Men and Postmenopausal Women Effects of Hyperprolactinemia SERUM PROLACTIN CONCENTRATION AND&hellip;<\/p>\n","protected":false},"featured_media":0,"template":"","oen_topic_chapter":[682],"class_list":["post-4422266","oen_topic","type-oen_topic","status-publish","hentry","oen_topic_chapter-pituitary-gland"],"_links":{"self":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422266","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic"}],"about":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/types\/oen_topic"}],"version-history":[{"count":6,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422266\/revisions"}],"predecessor-version":[{"id":4422273,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422266\/revisions\/4422273"}],"wp:attachment":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/media?parent=4422266"}],"wp:term":[{"taxonomy":"oen_topic_chapter","embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic_chapter?post=4422266"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}