Learn how this pituitary gland tumor alters certain hormone levels and leads to problems such as infertility, decreased libido and vision difficulties.
Prolactinoma is a noncancerous tumor of the pituitary gland. This tumor causes the pituitary to make too much of a hormone called prolactin. The major effect of prolactinoma is decreased levels of some sex hormones — estrogen in women and testosterone in men.
Although prolactinoma isn't life-threatening, it can cause vision difficulties, infertility and other problems. Prolactinoma is the most common type of hormone-producing tumor that can develop in your pituitary gland.
Doctors can often treat prolactinoma with medications to restore your prolactin level to normal. Surgery to remove the pituitary tumor also might be an option.
Prolactinoma might not cause any noticeable signs or symptoms. However, excessive prolactin in your blood (hyperprolactinemia) or pressure on surrounding tissues from a large tumor can cause signs or symptoms. Because elevated prolactin can disrupt the reproductive system (hypogonadism), some of the signs and symptoms of prolactinoma are specific to females or males.
In females, prolactinoma can cause:
In males, prolactinoma can cause:
In both sexes, prolactinoma can cause:
Women tend to notice signs and symptoms earlier than men do, when tumors are smaller in size, probably because of missed or irregular menstrual periods. Men tend to notice signs and symptoms later, when tumors are larger and more likely to cause headache or vision problems.
If you develop signs and symptoms associated with prolactinoma, see your doctor to determine the cause.
Prolactinoma is one type of tumor that develops in the pituitary gland. The cause of these tumors is unknown.
The pituitary gland is a small bean-shaped gland situated at the base of your brain. Despite its small size, the pituitary gland influences nearly every part of your body. Its hormones help regulate important functions such as growth, metabolism, blood pressure and reproduction.
Other possible causes of prolactin overproduction include medications, other types of pituitary tumors, an underactive thyroid gland, ongoing irritation to the chest, pregnancy and breast-feeding.
More prolactinomas occur in women than men. The disorder is rare in children.
Complications of prolactinoma may include:
If you have prolactinoma and you want to become or are already pregnant, talk to your doctor. Adjustments in your treatment and monitoring may be necessary.
If you have signs and symptoms that suggest you have prolactinoma, your doctor may recommend:
In addition, your doctor may refer you for more extensive testing with a doctor who specializes in treating disorders of the endocrine system (endocrinologist).
Goals in the treatment of prolactinoma include:
Prolactinoma treatment consists of two main therapies: medications and surgery.
Oral medications often can decrease the production of prolactin and eliminate symptoms. Medications may also shrink the tumor. However, long-term treatment with medications is generally necessary.
Doctors use drugs known as dopamine agonists to treat prolactinoma. These drugs mimic the effects of dopamine — the brain chemical that normally controls prolactin production. Commonly prescribed medications include bromocriptine (Cycloset, Parlodel) and cabergoline. These drugs decrease prolactin production and may shrink the tumor in most people with prolactinoma.
Nausea and vomiting, nasal stuffiness, headache, and drowsiness are common side effects of these medications. However, these side effects often can be minimized if your doctor starts you with a very low dose of medication and gradually increases the dose.
There have been rare cases of heart valve damage with cabergoline, but it's usually in people taking much higher doses for Parkinson's disease. Some people may develop compulsive behaviors, such as gambling, while taking these medications.
If medication shrinks the tumor significantly and your prolactin level remains normal for two years, you may be able to taper off the medication with your doctor's guidance. However, recurrence is common. Don't stop taking your medication without your doctor's approval.
Bromocriptine is more commonly prescribed when treating women who want to restore their fertility. However, once you become pregnant, your doctor will likely advise you to stop taking either medication.
Although both drugs are considered safe in early pregnancy, their safety throughout pregnancy isn't known. 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 prolactinoma.
If you're being treated for prolactinoma and you'd like to start a family, it's best to discuss your options with your doctor before you become pregnant.
Surgery to remove the tumor is generally an option if drug therapy for prolactinoma doesn't work or you can't tolerate the medication. Surgery may be necessary to relieve 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:
The outcome of surgery depends on the size and location of the tumor and your prolactin levels before surgery, as well as the skill of the surgeon. The higher the prolactin level, the slimmer the chance that prolactin production will return to normal after surgery.
Surgery corrects the prolactin level in most people with small pituitary tumors. However, many pituitary tumors come back within five years of surgery. For people with larger tumors that can only be partially removed, drug therapy often can return the prolactin level to a normal range after surgery.
For people who don't respond to medication and aren't candidates for surgery, radiation therapy may be an option.
You'll likely start by seeing your family doctor. You may then be referred to a doctor who specializes in disorders that affect your glands and hormones (endocrinologist).
Here's some information to help you get ready for your appointment.
Preparing a list of questions can help you make the most of your time with your doctor. For prolactinoma, some basic questions to ask include:
Don't hesitate to ask any other questions.
Your doctor is likely to ask you questions, including:
April 9th, 2021