Prolactinoma (patient information)

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 * Associate Editor-In-Chief: Jinhui Wu, M.D.

Overview
A prolactinoma is a benign pituitary tumor that produces a hormone called prolactin. It can affect women and men. The cause is not clear. Usual symptoms include abnormal milk flow from the breast in a woman who is not pregnant or nursing, breast tenderness, decreased sexual interest, headache, infertility and vision changes. Prolactin levels in blood and cranial magnetic resonance imaging scan can help the diagnosis. Treatments include medications such as bromocriptine, surgery, radiation therapy and gamma knife.

What are the symptoms of prolactinoma?
Early prolactinoma does not have any symptoms. As the tumor grows larger, people may notice one or more of the following symptoms:


 * Abnormal milk flow from the breast in a woman who is not pregnant or nursing
 * Breast tenderness in women
 * Stopping of menstruation not related to menopause
 * Decreased sexual interest
 * Headache
 * Infertility
 * Vision changes

Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible. Diseases with similar symptoms are:
 * Pituitary tumors that do not release prolactin
 * Hypothalamus tumor

Who is at highest risk?
Prolactinoma is the most common type of pituitary tumor (adenoma). It makes up at least 30% of all pituitary adenomas. Most pituitary tumors are noncancerous (benign). Prolactinoma may occur as part of a hereditary disorder called multiple endocrine neoplasia type 1 (MEN 1)

Prolactinomas occur most commonly in people under age 40. They are about five times more common in women than men, but are rare in children.

At least half of all prolactinomas are very small (less than 1 cm or 3/8 of an inch in diameter). These microprolactinomas are more common in women. Many small tumors remain small and never get larger.

Larger tumors, called macroprolactinomas, are more common in men. Prolactinomas in men tend to occur at an older age and can grow to a large size before any symptoms appear.

Diagnosis

 * Prolactin levels in blood: The blood level of prolactin in patients with prolactinoma may be higher than normal.
 * Testosterone levels in men: Blood levels of testosterone in men with prolactinoma may decrease.
 * Computed tomography (CT) scan: Cranial CT scans are often used to diagnose prolactinoma. It can confirm the location of the tumor and show the tissues nearby.
 * Magnetic resonance imaging (MRI): An cranial MRI uses magnetic fields but which is a different imaging type from computed tomography (CT) to produce detailed images of the body. Like computed tomography (CT), a contrast agent may be injected into a patient’s vein to create a better picture. Cranial MRI can show a pituitary mass in the patient.

When to seek urgent medical care?

 * Call your health care provider if symptoms of prolactinoma develop.
 * If you have had a prolactinoma in the past, call your health care provider if the symptoms return.

Treatment options
Patients with prolactinoma have many treatment options. Not everyone needs treatment. The selection depends on the symptoms and the size of the tumor. The options are medication, surgery, radiation therapy and gamma knife. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Side effect may not be the same for each person, and they may change from one treatment session to the next.


 * Medication: Medication is usually successful in treating prolactinoma. Bromocriptine and cabergoline are drugs that reduce prolactin levels in both men and women. They usually must be taken for life.
 * Surgery: Surgery is done in some cases where the tumor may damage vision.
 * Radiation therapy and gamma knife: These treatments are usually reserved for patients with prolactinoma that continues or gets worse after both medication and surgery.

Where to find medical care for prolactinoma?
Directions to Hospitals Treating prolactinoma

Prevention of prolactinoma
Because the cause of prolactinoma is not clear, the preventive measure is unknown.

What to expect (Outook/Prognosis)?
The prognosis of prolactinoma depends on the following:


 * Whether or not the tumor can be removed by surgery.
 * The patient’s general health
 * Whether the cancer has just been diagnosed or has recurred

Possible Complications
If untreated, a growing tumor can press on the optic nerves and cause:
 * Bleeding
 * Tumor regrowth


 * Blindness
 * Double vision
 * Permanent vision loss