Prolactinoma Flashcards
Define Prolactinoma?
A pituitary adenoma that overproduces prolactin
What are the different types of Prolactinoma?
Microadenomas < 1cm
Macroadenomas > 1cm
Giant Pituitary Adenomas > 4 cm
Malignant Prolactinoma (RARE)
What is the aetiology of Prolactinoma?
Cause if UNKNOWN
Some may occur as a consequence of MEN 1 syndrome
What are the risk factors of Prolactinoma?
Risk of tumour enlargement in pregnancy
What is the epidemiology of Prolactinoma?
Relatively Common
Higher incidence in premenopausal women
What’s important to remember with prolactinomas?
Microprolactinomas rarely expand to become macroprolactinomas
What are the presenting symptoms and signs of Prolactinoma in Women?
Amenorrhoea/oligomenorrhoea Galactorrhoea Infertility Hirsuitism Reduced Libido
What are the presenting symptoms and signs of Prolactinoma in Men?
Symptoms are subtle and develop slowly
Reduced libido
Reduced beard growth
Erectile dysfunction
What are the symptoms caused by tumour size in Prolactinoma?
Headache
Visual Disturbance (bitemporal hemianopia)
Cranial Nerve Palsies
Signs and Symptoms of hypopituitarism
What are the investigations you would do for Prolactinoma?
Exclude pregnancy
TFTs - hypothyroidism leads to highTRH leads to stimulates prolactin release
Serum prolactin level (extremely high levels (> 5000 mU/L) suggests true prolactinoma
MRI
Assessment of pituitary function
What are the goals of the management plan of Prolactinoma?
Treat Cause
Relieve symptoms
Prevent complications
Restore fertility
What is the main management plan for Prolactinoma?
Dopamine Agonists (e.g. cabergoline and bromocriptine)
How are Dopamine Agonists used for Prolactinoma?
Effective in most patients
Usually need to be continued on a long-term basis
What do you do for Prolactinoma if dopamine agonists are ineffective?
Surgery
Radiotherapy
What are the complications of Prolactinoma?
Complications of hypogonadism
Complications of tumour size
