pituitary adenoma/prolactin secreting (prolactinoma)
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Epidemiology
- most common functional pituitary tumor
Pathology
- women
- almost always small tumors (microadenomas)
- clinical course is benign
- tumors rarely enlarge
- men
- generally large tumors (macroadenomas)
- often aggressive tumors
Genetics
- associated with defects in AIP
Clinical manifestations
- women
- oligomenorrhea
- galactorrhea in 1/3 of patients
- hirsuitism
- men
- erectile dysfunction
- gynecomastia not necessarily present[1]
- galactorrhea not necessarily present[1]
- both sexes
- infertility
- decreased libido
- headache
- osteopenia
Laboratory
- serum prolactin
- elevated with prolactinoma; > 200 ng/mL confirms diagnosis
- if < 200 ng/mL, also consider hypothyroidism
Diagnostic procedures
- formal visual field testing each trimester[1]
Radiology
Complications
- prolactinomas may increase in size in pregnant women resulting in visual field loss[1]
Differential diagnosis
Management
- microprolactinomas in asymptomatic patients may be observed[1]
- women
- dopaminergic agonist*
- cabergoline preferred agent[1]
- carbergoline 0.25 mg twice weekly
- bromocryptine 5-10 mg PO QD
- treat when fertility is the goal
- cabergoline preferred agent[1]
- surgery
- prolactinomas not responding to dopaminergic agonist[1]
- most patients treated surgically relapse
- overall surgical mortality is 1%
- 50% of prolactinomas recur after resection[1]
- treat with birth control pills between pregnancies to ensure effective contraception, normal menses & skeletal integrity
- dopaminergic agonist*
- men
- bromocryptine*
- cabergoline*[1]
- trans-sphenoidal surgical resection
- reserved for patients who fail bromocryptine
- risk of morbidity & mortality
* dopaminergic agonists decrease size of prolactinomas > 50% in 80-90% of patients[1]
- initial management of prolactinoma with suprasellar extension & compression against the optic chiasm is dopamine agonist therapy[4]
More general terms
Additional terms
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2018.
- ↑ Klibanski A Clinical practice. Prolactinomas. N Engl J Med. 2010 Apr 1;362(13):1219-26 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20357284
- ↑ Mann WA Treatment for prolactinomas and hyperprolactinaemia: a lifetime approach. Eur J Clin Invest. 2011 Mar;41(3):334-42.
- ↑ 4.0 4.1 NEJM Knowledge+
- ↑ National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) web page "Prolactinoma" http://www.niddk.nih.gov/health/endo/pubs/prolact/prolact.htm