What is prolactinoma and how does it happen?
The pituitary gland is a small gland at the base of the brain that controls the functioning of other endocrine organs. Cells that produce prolactin can form a benign nodule that continues to secrete the hormone regardless of the body's needs. Based on tumor size, tumors are divided into microadenomas, less than one centimeter, and macroadenomas, more than a centimeter. Microadenomas are more common in women and are manifested by hormonal disorders, macroadenomas - in men and are often detected late, when pressure appears on the optic chiasm.
- Microadenoma - less than 10 mm
- Macroadenoma - 10 mm or more
- The tumor is benign and does not metastasize.
- Grows slowly, often for years
- May be part of hereditary syndromes
Other causes of high prolactin
Before talking about a tumor, the doctor rules out more common causes. Prolactin physiologically increases during pregnancy and lactation, during stress, physical activity, sleep, and even from an unpleasant injection during blood sampling. It is raised by many medications: antipsychotics, some antiemetics and antidepressants, blood pressure medications. Untreated hypothyroidism has a significant impact. Separately, there is the phenomenon of macroprolactin - a bound inactive form of the hormone that overestimates the test result without causing any symptoms.
- Pregnancy and breastfeeding
- Stress, pain, physical activity before analysis
- Neuroleptics, antiemetics, some antidepressants
- Untreated hypothyroidism
- Chronic kidney disease and liver cirrhosis
- Macroprolactin is a laboratory phenomenon
- Compression of the pituitary stalk by another tumor
Symptoms
In women of childbearing age, the first sign is usually a cycle disorder: periods come rarely, sparingly, or stop altogether. Often drops of colostrum appear from the nipples outside of pregnancy and difficulties in achieving pregnancy. In men, the symptoms are less noticeable and are attributed to fatigue: libido decreases, erection deteriorates, muscle mass and facial hair growth decrease. Symptoms common to both sexes are a decrease in bone density over a long period of time. A large tumor adds persistent headache and narrowing of visual fields.
- Irregular or absent menstruation
- Breast discharge outside of pregnancy
- Difficulty conceiving
- Decreased libido and erectile dysfunction
- Headache
- Loss of lateral visual fields
- Decreased bone density
Diagnostics
Blood for prolactin is donated in the morning, in a calm state, without physical activity or sexual activity the day before; If the result is borderline, the analysis is repeated. Be sure to check TSH and exclude pregnancy, clarify the list of medications taken, and, if necessary, determine macroprolactin. If a high level is confirmed and other causes are excluded, an MRI of the pituitary gland is prescribed, preferably with contrast: this is the main method for detecting adenoma. In case of macroadenoma, visual fields are additionally checked by an ophthalmologist and the function of other pituitary hormones is assessed.
- Prolactin in the morning, repeat if necessary
- Pregnancy test and TSH
- Determination of macroprolactin
- Sex hormones and assessment of pituitary function
- MRI of the pituitary gland with contrast
- Visual field check
- Long-term densitometry
Treatment
The main method is drugs from the group of dopamine agonists. They reduce prolactin production and, in most patients, reduce tumor size, restoring the cycle, fertility and sexual function. The treatment is long-term, the dose is selected by the endocrinologist based on hormone levels and MRI data; with stable normalization after several years, an attempt at withdrawal under supervision is possible. Nasal surgery is suggested in case of intolerance or ineffectiveness of drugs, compression of the visual tract and hemorrhage into the tumor. Radiation treatment is rarely used in resistant cases. You cannot stop taking medications on your own.
- Dopamine agonists as first line
- Monitoring prolactin and MRI over time
- Transnasal surgery when indicated
- Radiation therapy in rare resistant cases
- Observation by an ophthalmologist for macroadenoma
- Planning pregnancy with an endocrinologist
- Correction of hypothyroidism and review of medications