{"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 TUMOR SIZE TREATMENT CONSIDERATIONS Indications for Treatment Mainstay of Therapy: Dopamine Agonists Monitoring and Dosage Adjustment Potential \u201cCure\u201d Special Considerations<\/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","post-wrapper","thrv_wrapper"],"_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}]}}