(!) prolactinoma

Question 1

Define prolactinoma

Answer 1

Prolactinomas are benign lacotroph adenomas expressing and secreting prolactin

Represent about 40% of all Pit adenomas, which are the 3rd most common CNS tumour

Question 2

Aetiology and risk factors of prolactinoma

Answer 2

Monoclonal in origin-singles cells grow out of control
most often polygenic +environement. Rarely due to MEN1 or familial
Hyperprolactinoma causes secondary hypo-gonadotroph

risk factors
Women
Child baring age
1 peak at 20-30
Peak at 60 (this time gender balanced)
FHx

Question 3

Epdiemology of prolactinoma

Answer 3

Most common form of Pit adenoma-40%
and Pit adenoma are 3rd most common CNS tumour
Most common women of child baring age
around 620 per million

Question 4

Signs and Sx of Prolactinoma

Answer 4

Hypogonadism-
Loss of libido
Infertility
Gallactorrhoa–main clue

Men-erectile dysfunction, loss of hair in testosterone areas,

Women-ammenorhoa/oligomennorhoea
Sx of menopause-hot flush, insomnia
Osteoporosis

Pit related-
Headaches,
Visual disturbance-bitemporal hemianopia
Cranial nerve compression/disturbance

Question 5

Investigations of prolactinoma

Answer 5

Serum prolactin-high
Pit MRI-sellar mass
Visual fields-bitemporal hemianopia

Question 6

Management of prolactinoma

Answer 6

Dopamine inhibits prolactin
Dopamine agonists-
Carbegoline 1st line-shrinks tumour and normalises sydromes
bromocriptide 2nd line

can get resistance to agonists

Question 7

Complications of prolactinoma

Answer 7

Dopamine agonists can have issues-high dose carbegolinecan cause valvular heart disease-but not at prolactinoma dose
can also get withdrawal

Visual fields impairment

Hypopituarism
anterior pit failure/diabetes insidious
hypopit from radiotherapy

Question 8

Prognosis of prolactinoma

Answer 8

Now that dopamine agonist exists-much better
can lead to very significant reduction in size and even disappearance
rapid visual field improvements

withdrawal can be started several years later with no recurrence