Prolactinoma

Question 1

define:

Answer 1

pituitary adenoma that produces prolactin

Question 2

Aetiology/risk factors:

Answer 2

Micro <1cm
Macro >1cm
Giant >4cm

Can be due to MEN-1 syndrome

Risk of tumour enlargement in pregnancy

Question 3

Epidemiology:

Answer 3

Presents in women younger
More common in premenopausal women
relatively common

Question 4

Symptoms/signs in women:

Answer 4

Amenorrhea/oligiorrhea 
Decreased libido
Galactorrhea 
Osteoporosis weakness
Dry vagina 
Hirsutism
Infertility

Question 5

Symptoms/signs in men:

Answer 5

Gynaecomastia 
Impotence 
erectile dysfunction
Decrease libido 
Infertility 
reduced beard growth

Question 6

Symptoms/signs of tumour size:

Answer 6

Visual disturbances (bitemporal hemianopia)

Cranial nerve palsies

Signs/symps of hypopituitirism

Headaches

Question 7

Investigations:

Answer 7

EXCLUDE PREGNANCY

TFT’s - may find high TRH which stimulates the release of prolactin

High serum prolactin

MRI pituitary

Assessment of pituitary function

Question 8

Management:

Answer 8

Treat the cause, relieve symptoms, prevent complications and restore fertility

Dopamine agonists :

• Bromocriptine
• Carbergoline - less side effects (nausea, depression and postural hypotension) and more effective

If medical treatment fails or macro:
Surgery - trans-sphenoidal

Radiotherapy

Question 9

Complications:

Answer 9

Osteoporosis 
Infertility 
Erectile dysfunction 
Visual loss 
Headache 
Pituitary apoplexy 
CSF rhinorrhoea

Question 10

Prognosis:

Answer 10

1/3 of micro will resolve on their own

high recurrence rate

dopamine agonist withdrawal 1-3 years later is prolactin level normalised