Adrenal and Gonads - CS7: Prolactinoma

Question 1

What is the primary diagnosis for a patient presenting with elevated prolactin levels, menstrual irregularities, galactorrhea (milk secretion), and infertility?

Answer 1

Prolactinoma (a benign tumor of the pituitary gland causing excessive prolactin production).

Question 2

What are common symptoms associated with prolactinoma in females?

Answer 2

Menstrual irregularities, galactorrhea, and infertility.

Question 3

What is the most common symptom of prolactinoma in males?

Answer 3

Impotence and decreased libido, with potential gynecomastia (breast enlargement).

Question 4

What is the first-line treatment for prolactinoma?

Answer 4

Dopamine agonists (e.g., cabergoline or bromocriptine), which inhibit prolactin secretion and can shrink the tumor.

Question 5

How is prolactinoma diagnosed?

Answer 5

Elevated prolactin levels and confirmed by MRI to detect the pituitary tumor.

Question 6

How can you differentiate between a functioning and non-functioning pituitary adenoma in a patient presenting with visual disturbances and symptoms of hypopituitarism?

Answer 6

Functioning adenomas secrete excess hormones, causing symptoms like galactorrhea (prolactinoma), Cushing’s syndrome (corticotroph adenoma), acromegaly (somatotroph adenoma), or hyperthyroidism (thyrotroph adenoma).

Non-functioning adenomas do not secrete hormones but cause symptoms by compressing nearby structures, leading to visual disturbances or hypopituitarism (deficient hormone production).

Key tests like hormone levels and imaging help make the diagnosis.