Prolactinoma Flashcards
def
a benign tumour (adenoma) which secretes prolactin
aetiology
majority are caused by sporadic mutation of pituitary cells which stimulates the increased cellular growth rate
epi
most common type of pituitary adenoma
women>men at child-bearing age
risk factors
female
child-bearing age
history
in women
1 amenorrhoea or oligomenorrhoea (missing periods or infrequent periods)
2 galactorrhoea
2 infertility
in men
1 erectile dysfunction
2 loss of libido (in women too)
why does high prolactin cause infertility
inhibits ovulation
why does high prolactin cause loss of libido
hyperprolactinaemia causes secondary hypogonadism
examination
1 gallactorrhoea
2 visual changes
-bitemporal hemianopia caused by large pituitary tumour pressing on the optic chiasm
investigations
1 bloods
-high prolactin
2 imaging (pituitary MRI)
-asymptomatic pituit
why is in important to confirm an elevated prolactin before ordering a pituitary MRI
it is common to find asymptomatic pituitary adenomas in the normal population
management
primary goal of management is to reduce prolactin levels to restore ovulation in women and to normalise testosterone and sexual function in men
additionally management to reduce the size of the tumour which may be causing visual defects
1 dopamine agonists such as cabergoline are first line
-inhibit prolactin
2 patients who do not respond to dopamine agonists are considered dopamine resistant and instead undergo surgery for prolactinoma resection
management of a pre-menopausal woman
asymptomatic - observations
symptomatic:
1 first line is a dopamine agonist (cabergoline)
2 second line is COCP, this is for woman with small prolactinomas presenting only with menstrual irregularities and no desire to become pregnant
3 prolactinoma resection
management of a men
1 first line is a dopamine agonist (cabergoline)
2 prolactinoma resection
complications
1 visual defects
-bilateral hemianopia
2 anterior pituitary failure and/or diabetes insipidus if surgery is complicated
prognosis
good prognosis
