Prolactinoma

Question 1

Define prolactinoma.

Answer 1

Prolactinomas are benign lactotroph adenomas expressing and secreting prolactin.

Question 2

Explain the aetiology/risk factors of prolactinoma.

Answer 2

Female gender, 20 to 50 years of age
Genetic predisposition
Oestrogen therapy
Male gender, 30 to 60 years of age

Question 3

Summarise the epidemiology of prolactinoma.

Answer 3

Prolactinomas are the most common type of pituitary adenoma, constituting about 40% of these tumours.

Question 4

Recognise the presenting symptoms of prolactinoma. Recognise the signs of prolactinoma on physical examination.

Answer 4

Amenorrhoea or oligomenorrhoea
Infertility
Galactorrhoea
Loss of sexual desire (libido)
Erectile dysfunction
Visual deterioration (e.g., temporal hemianopia)
Osteoporosis

Question 5

Identify appropriate investigations for prolactinoma and interpret the results.

Answer 5

Serum prolactin
Pituitary MRI
Computerised visual-field examination

Question 6

Generate a management plan for prolactinoma.

Answer 6

Cabergoline/bromocriptine
Octreotide
Transsphenoidal hypophysectomy

Question 7

Identify the possible complications of prolactinoma and its management.

Answer 7

Visual field impairment
Anterior pituitary failure and/or diabetes insipidus
Hypopituitarism associated with radiotherapy
Cabergoline-associated valvular insufficiency
Pituitary apoplexy
Cerebrospinal fluid leakage

Question 8

Summarise the prognosis for patients with prolactinoma.

Answer 8

This benign disease follows a progressive improving course while medically treated. In some patients, dopamine agonist treatment may be withdrawn after several years without tumour recurrence.