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Prolactinoma

What is Prolactinoma?

Prolactinoma is a condition in which the lactotrophs (Prolactin secreting cells) of the pituitary gland proliferate to form a benign swelling (adenoma) and secret excessive amounts of prolactin.

When the size of the pituitary swelling (adenoma) is < 1 cm, it is considered as “Microprolactinoma”. When the size of the pituitary swelling (adenoma) is > 1 cm, it is considered as “Macroprolactinoma”.

What are the symptoms?

In women,

  • Cessation of menstrual periods/amenorrhoea
  • Galactorrhoea (Discharge from the breast)
  • Infertility
  • Visual field defects (Inability to see the whole view)

In men, the presentation may be only with infertility, decreased libido, impotence or decreased visual field. Very rarely men can develop breast enlargement (Gynaecomastia) and breast discharge. Usually it is diagnosed late in men. Hence most of the times, men have macroprolactinoma.

What are the tests to confirm?

  • Prolactin levelsIf the prolactin levels are very high, test might have to be done by a technique called as “dilution method” to avoid false negative result. Pooled sample (Sample collected 3 times at 20 minutes intervals) might be necessary in few patients.
  • Pituitary MRI with contrast

How do we treat?

Prolactinoma responds very well to medical management. Cabergoline, given in weekly once or twice schedule reduces both prolactin levels and the size of pituitary adenoma. Minimum 4-5 years of therapy will be needed to achieve complete cure.

Rarely, if the patients are not responding surgery or radiotherapy may be needed.

Even after cure, it is better to check prolactin levels yearly once to find out whether relapse has occurred.

Drugs (Recombinant hCG and FSH) might be needed to treat related infertility.

How is the prognosis?

Prolactinoma is one of the rare tumor which responds/gets cured with drugs. If the medications are taken properly prognosis is very good.

When to Contact an Endocrinologist?

If anyone develops symptoms of prolactinoma (galactorrhoea/amenorrhoea) it is better to consult an Endocrinologist.

 

Endocrinologists are trained very well in the management of prolactinoma.

Key Features of Prolactinoma
Breast discharge
Absent menstrual cycles
Infertility
Beauty of Prolactinoma is that it responds very
well to a drug (Cabergoline) weekly once

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