prolactinoma Flashcards
define prolactinoma?
a pituitary adenoma that overproduces prolactin
how can prolactinomas be catagorised?
either by size o Microadenomas: < 1 cm o Macroadenomas: > 1 cm o Giant Pituitary Adenomas: > 4 cm o Malignant Prolactinoma (RARE) or by hormonal status o Functioning adenoma (produces hormone) o Non-functioning adenoma (does not make hormone)
what are the risk factors of a prolactinoma?
o Risk of tumour enlargement in pregnancy
o MEN 1 syndrome
epidemiology of a prolactinoma?
- Relatively common
* Higher incidence in premenopausal women
presenting symptom of a prolactinoma in women?
o Amenorrhoea/oligomenorrhoea o Galactorrhoea o Infertility o Hirsuitism o Reduced libido
presenting symptoms of a prolactinoma in men?
o Symptoms are subtle and develop slowly
o Reduced libido
o Reduced beard growth
o Erectile dysfunction
what symptoms are caused by large tumour?
o Headache
o Visual disturbance
o Cranial nerve palsies
o Signs and symptoms of hypopituitarism
what is the gold standard investigation for prolactinoma?
• MRI
what other investigations are necessary?
• Exclude pregnancy • Serum prolactin level o Normal = <500mlU/l o Very high = 6000mlU/l • TFTs • Assessment of pituitary function
first line treatment for prolactinomas?
• Dopamine Agonists (e.g. cabergoline and bromocriptine)
what is recommended if the patient cannot tolerate a dopamine agonist?
trans-sphenoidal approach
what are the complications of a prolactinoma?
• Complications of hypogonadism o Osteoporosis o Reduced fertility o Erectile dysfunction • Complications of tumour size o Visual loss o Headache o Pituitary apoplexy o CSF rhinorrhoea
prognosis?
- Micro-prolactinomas will spontaneously resolve in about 1/3 cases
- High rates of recurrence
