Prolactinoma

1 What is Prolactinoma?

Prolactinoma is the most usual type of hormone-producing tumor which is noncancerous, called adenoma, which can grow in your pituitary gland that brought about by the brain’s overproduction of the hormone prolactin.

Symptoms of prolactinoma are non-life-threatening such as poor or defective vision, may lead to infertility and create other effects.

Non-surgical treatment for prolactinoma is by providing a medication that allows normalization of prolactin’s level, while surgical treatment include removal of the noncancerous tumor in the pituitary gland.

2 Symptoms

There may be no noticeable signs or symptoms from prolactinoma. However, Signs and symptoms of prolactinoma may be due to an elevated prolactin in your bloodstream called hyperprolactinemia or impediment of surrounding tissues due to growth of a large tumor.

The increased prolactin, causes different signs and symptoms of the condition for males and females, since it directly affect the reproductive system called hypogonadism.

Effects of prolactinoma in women include, irregular menstrual periods (oligomenorrhea) or no menstrual periods (amenorrhea), milky or cloudy discharge from the breasts (galactorrhea) when not pregnant or breast-feeding, painful intercourse due to vaginal dryness, acne and excessive body and facial hair growth (hirsutism).

While in males, the effect of prolactinoma are as follows erectile dysfunction, decreased body and facial hair and atypically, enlarged breasts (gynecomastia).

Both genders may also suffer from low bone density, reduced hormone production by the pituitary gland (hypopituitarism) cause by the pressure of the pressing tumor, loss of interest in sexual activity, headaches, visual disorders and infertility. Although in the beginning signs and symptoms may not be noticeable but women tend to start seeing symptoms earlier than men, probably because menstrual period is a regular monthly occurrence that they are used to and is noticeable when missed.

On the other hand, men has the tendency to suspect something is going on when the condition is on the advanced staged such as when the tumor has already grown, large enough to cause visual impairment and increased intensity of headaches.

3 Causes

Prolactinoma is a type of hormone-producing tumor that is found in the pituitary gland but its cause is still not known. The pituitary gland despite its small size as it is only a bean-shaped gland found inferior to the brain plays a role in most of the body functions.

As the pituitary gland secretes different hormones that facilitates different body functions including growth, blood pressure regulation and reproduction.

Additional causes of overproduction of prolactin are due to medications, other types of pituitary tumors, an under functioning of the thyroid gland, chest injury, pregnancy and breast-feeding.

4 Making a Diagnosis

Making a diagnosis of prolactinoma is done by performing several tests.

You will be referred to an endocrinologist which is a doctor that specializes with the disorders that affect your glands and hormones for a more specialized treatment and expertise on the diagnosis.

To be able to maximize the time spent with the doctor and not waste any time, here are some things to know about on how you can best prepare for your appointment. Prepare a list of all the symptoms that you are experiencing including all those that you feel may not be related to the condition.

For women, it is important to have a record of your menstrual history, such as your age when you starting having menstrual period, regularity of the menstruation, as well as use of contraceptives.

Note personal information such as an altering life changes and cause of major stressor. Also, have a list of all medications that you have taken or is taking including supplements and vitamins.

For better management and coping with the condition, it is beneficial to understand it hence ask your doctor questions that you might find confusing or is concerned about regarding prolactinoma, and such questions may be as follows:

  • What is this condition and what caused the symptoms?
  • What could have contributed to the development of this illness?
  • What tests are necessary for diagnosis and are there preparations that I need to do prior to the test?
  • What are the available treatments and would you recommend for my situation?
  • What are the side effects of the treatment?
  • If surgery is needed, will it cure the illness?
  • How will I best manage my other health problems with the treatment given?
  • Will infertility be cured?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there available reading materials that I can take home and study?
  • What other resources would you recommend for me to better understand prolactinoma?

As part of the doctor’s assessment, questions would also be asked to you such as:

  • When did you first notice the symptoms?
  • What is the frequency to which you experience the symptoms?
  • Is there any measure that can help with the symptoms?
  • Is there anything that triggers the symptoms?
  • Do you have any family member who has had problems with high calcium levels, kidney stones or tumors in endocrine glands?

Further evaluations will be conducted through diagnostic tests. Blood tests can show the overproduction of prolactin and the levels of other hormones controlled by the pituitary are abnormally high or low. As a precaution, women of childbearing age also will have to take a pregnancy test.

A pituitary tumor may be suspected hence brain imaging will also be done. A Vision tests will be done as well, to rule out if there is an impairment in vision caused by a pituitary tumor.

5 Treatment

Treatment of prolactinoma is multi-layer as it involves:

  • return prolactin production to normal levels,
  • restore normal pituitary gland tasks,
  • reduce the size of the pituitary tumor,
  • eradicate any signs and symptoms associated with tumor pressure such as headaches or impairment in vision,
  • over-all improve the quality of life.

Medications and surgeries are the two main focus of treatment for prolactinoma. Oral medications usually can reduce the production of prolactin therefore eliminating symptoms. It is also possible for the medications to decrease the size of the tumor.

However, long-term treatment with medications is generally required. A drug called dopamine agonists is used to treat prolactinoma, these drugs imitate the effects of dopamine which is the brain chemical that regulate prolactin production, but are much more potent and long lasting.

Frequently recommended medications include bromocriptine (Cycloset, Parlodel) and cabergoline. These drugs reduce prolactin production and may decrease the size of the the tumor in a lot of people with prolactinoma.

Bromocriptine is the drug of choice for treating women who want to reinstate their fertility. However, once you become pregnant, there is a greater chance that the medication will be stopped as it puts the pregnancy at risk since its effect after the early stages of pregnancy is still unknown.

However, if you have a large prolactinoma or you develop signs and symptoms such as headaches or vision changes, your doctor may recommend that you restart your medication to prevent complications from the prolactinoma. Work closely with your doctor and talk about your desire to be pregnant while you are taking medications for prolactinoma.

Common side effects Nausea and vomiting, nasal stuffiness, headache, and drowsiness are common side effects of these medications. However, gradual increase in the dosage would reduce the possibility of experiencing side effects.

Cabergoline is the preferred medication as it has some to be more effective than bromocriptine, it also has less frequent and less serious side effects. However, it's more expensive than bromocriptine and is fairly newer in the marker since has lesser safety records.

There have been occasional cases of heart valve damage with Cabergoline, but generally occurs in people taking much higher doses for Parkinson's disease. Compulsive behaviors, such as gambling, may develop while taking these medications.

If medication significantly decrease the size of the tumor then the prolactin level remains normal for two years, in which you may be able to taper off the medication with your doctor's guidance. However, possibility of recurrence oftentimes happen.

Always consult your doctor before stopping the medication as it may generate an adverse effect or possible cause tolerance to it. If several medications fail to treat the condition or the person is unable to tolerate the medication due to side effects, then surgery to remove the pituitary tumor may be considered.

Also, surgery can facilitate relieving pressure on the nerves that control your vision. The type of surgery you have will depend largely on the size and extent of your tumor: Transsphenoidal surgery.

Most people who need surgery have this procedure, in which the tumor is removed through the nasal cavity in which the complication rates are low because no other areas of the brain are touched during surgery, and this surgery leaves no visible scars.

Another type of surgery is Transcranial surgery. This type of surgery is used when the tumor’s size is too big or has extended to the nearby tissue in which the surgeon would have to perform the procedure from the upper part of the skull.

The success of the surgery would depend on the size and extend of the tumor as well as the prolactin level before surgery. If the prolactin level is too high the possibility of it return to normal level is rare, also if the tumor is too big and extended, even if the surgeon is able to possible take out all the tumor, there is a greater change that the tumor will re-occur after 5 years.

In some instances, even after surgery and removal of tumor, medications are still prescribed to further decrease the prolactin level. In cases wherein the person is unresponsive to medication or is not a candidate for surgery then a possible treatment option is radiation therapy.

6 Prevention

The preventive measures are unknown because the cause of prolactinoma is unclear.

7 Alternative and Homeopathic Remedies

The homeopathic remedies for prolactinoma include:

  • Borax veneta if there is a vaginal discharge like white of an egg
  • Calcarea carbonica when there is a hot swelling of breasts or the breast is tender
  • Conium maculatum when the breast became painful to touch
  • Medusa
  • Secale cornutum for burning pains in the uterus

8 Lifestyle and Coping

To cope with prolactinoma, it is important to lead a healthy lifestyle as determined by your physician.

Reducing stress is essential in prolactinoma and consult your doctor regarding your Vitamin D for the hormonal balance.

9 Risks and Complications

There are several risks and complications associated with prolactinoma.

Prolactinoma can happen at any age in both men and women, although most cases are with women between the ages of 20 and 34.

Complications of prolactinoma include vision impairment because the pituitary tumor can grow large enough to compress the optic nerve if the condition is left without treatment.

Additional complications result from the hormonal insufficiency due to the increase pressure in the pituitary gland, such conditions include: hypothyroidism, adrenal insufficiency and growth hormone deficiency.

Osteoporosis may soon develop due to an increase level of prolactin which reduces the production of estrogen and testosterone leading to decreased bone density.

Pregnancy complications, a pregnant woman has an increased production of estrogen in which if the woman has prolactinoma, the high estrogen level causes the formation of tumor which will bright symptoms of headaches and changes in vision.

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