Prolactinoma Flashcards
Define prolactinoma
Pituitary adenoma that overproduces prolactin
Aetiology of prolactinoma
3
UNKNOWN cause
Some may occur as consequence of MEN 1 syndrome
Risk of tumour enlargement in pregnancy
Different types of prolactinomas
4
Microadenoma: < 1cm
Macroadenoma: > 1cm
Giant pituitary adenoma: > 4cm
Malignant prolactinoma (rare)
(microprolactinomas rarely expand to become macroprolactinomas)
Epidemiology of prolactinoma
prevalence + group
Relatively common
Higher incidence in premenopausal women
Presenting symptoms & signs of prolactinoma - women
5
Amenorrhoea/oligomenorrhoea Galactorrhoea Infertility Hirsutism Reduced libido
Presenting symptoms & signs of prolactinoma - men
4
Symptoms subtle & develop slowly
Reduced libido
Reduced beard growth
Erectile dysfunction
Presenting symptoms & signs of prolactinoma - caused by tumour size
(4)
Headache
Visual disturbance (bitemporal hemianopia)
Cranial nerve palsies
Signs & symptoms of hypopituitarism
Investigations for prolactinoma
5
Exclude pregnancy
TFTs
hypothyroidism —> high TRH —> stimulate prolactin release
Serum prolactin level
extremely high levels (> 5000mU/L) suggest true prolactinoma
MRI
Assessment of pituitary function
Management of prolactinoma (3 groups)
Goals
Dopamine agonists
Surgery/radiotherapy
Management of prolactinoma - goals
4
Treat cause
Relieve symptoms
Prevent complications
Restore fertility
Management of prolactinoma - dopamine agonists
3
e.g. cabergoline & bromocriptine
Effective in most patients
Usually need to be continued long term
Management of prolactinoma - surgery/radiotherapy
If dopamine agonists are ineffective
Complications of prolactinoma
due to 2
Hypogonadism
Tumour size
Complications of prolactinoma - hypogonadism
3
Osteoporosis
Reduced fertility
Erectile dysfunction
Complications of prolactinoma - tumour size
4
Visual loss
Headache
Pituitary apoplexy
CSF rhinorrhoea
