What are prolactinomas, and what are the signs and symptoms of these tumors?

Updated: Mar 25, 2018
  • Author: Venkatesh Babu Segu, MD, MBBS, DM; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Prolactinomas, benign lesions that produce the hormone prolactin, are the most common hormone-secreting pituitary tumors. [1] Causing hyperprolactinemia, prolactinomas can reduce estrogen levels in women and testosterone concentrations in men and may result in infertility. Based on its size, a prolactinoma can be classified as a microprolactinoma (< 10 mm diameter) or a macroprolactinoma (>10 mm diameter). The tumor can be assessed through hormone testing and magnetic resonance imaging (MRI) or computed tomography (CT) scanning. Bromocriptine (BEC) is generally considered to be the agent of choice in the treatment of prolactinoma. Surgically, transsphenoidal pituitary adenomectomy is the preferred treatment in patients with microprolactinoma and in most patients with macroprolactinoma. [2]

Signs and symptoms of prolactinomas include the following:

  • Reproductive-aged females can present with menstrual disturbance and/or infertility [3]
  • Galactorrhea is not unusual and can be spontaneous or expressive (only upon squeezing of the nipples)
  • Other features of hypoestrogenism include vaginal dryness, dyspareunia, and a decline in bone mineral density (ie, osteopenia or osteoporosis) [4]
  • Men with prolactinoma have one or more features of hypogonadism, which may include decreased libido, erectile dysfunction, or infertility [5]
  • If a prolactinoma develops prepubertally, hyperprolactinemia may result in a female body habitus and small testicles
  • If the prolactinoma is large enough to compress the surrounding normal hormone-secreting pituitary cells, it may result in deficiencies of one or more hormones (eg, thyroid-stimulating hormone [TSH], growth hormone [GH], adrenocorticotropic hormone)
  • Larger tumors are frequently associated with headache secondary to stretching of the pain-sensitive structures around the pituitary gland [6]
  • Encroachment of surrounding tissues may result in visual problems in the form of field defects
  • Postmenopausal women and elderly men often present with the space-occupying effects of the tumor

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