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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''.
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| {{DiseaseDisorder infobox |
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| Name = Prolactinoma |
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| ICD10 = {{ICD10|D|35|2|d|10}} |
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| ICD9 = {{ICD9|253.1}} |
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| ICDO = 8271/0|
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| Image = |
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| Caption = |
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| OMIM = 600634 |
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| OMIM_mult = |
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| MedlinePlus = |
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| DiseasesDB = 10735 |
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| }}
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| {{Prolactinoma}} | | {{Prolactinoma}} |
| {{CMG}}
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| ==[[Prolactinoma overview|Overview]]==
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| ==[[Prolactinoma epidemiology and demographics|Epidemiology & Demographics]]==
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| ==[[Prolactinoma causes|Causes of Prolactinoma]]==
| | {{CMG}}; {{AE}} {{Anmol}}, {{Faizan}} |
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| ==[[Prolactinoma history and symptoms|History & Symptoms]]==
| | {{SK}} Prolactin secreting pituitary adenoma, lactotroph adenoma, prolactin cell adenoma, prolactin secreting adenoma, prolactin cell tumor |
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| == Diagnosis ==
| | ==[[Prolactinoma overview|Overview]]== |
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| ==[[Prolactinoma physical examination|Physical Examination]]== | |
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| ==[[Prolactinoma laboratory tests|Lab Tests]]==
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| ==[[Prolactinoma MRI|MRI]]==
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| ==[[Prolactinoma CT|CT]]==
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| == Treatments == | | ==[[Prolactinoma historical perspective|Historical Perspective]]== |
| The goal of treatment is to return prolactin secretion to normal, reduce tumor size, correct any visual abnormalities, and restore normal pituitary function. As mentioned above, the impact of stress should be ruled out before the diagnosis of prolactinoma is given. Exercise can significantly reduce stress and, thereby, prolactin levels. It should also be noted that higher prolactin levels may contribute to the development of prolactinomas so the diagnosis can be self-fulfilling if the original cause is stress. In the case of very large tumors, only partial reduction of the prolactin levels may be possible.
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| ==[[Prolactinoma medical therapy|Medical Therapy]]== | | ==[[Prolactinoma classification|Classification]]== |
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| ==[[Prolactinoma surgery|Surgery]]== | | ==[[Prolactinoma pathophysiology|Pathophysiology]]== |
| Surgery should be considered if medical therapy cannot be tolerated or if it fails to reduce prolactin levels, restore normal reproduction and pituitary function, and reduce tumor size. If medical therapy is only partially successful, this therapy should continue, possibly combined with surgery or [[radiation]] treatment.
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| The results of surgery depend a great deal on tumor size and prolactin level as well as the skill and experience of the [[neurosurgeon]]. The higher the prolactin level, the lower the chance of normalizing [[blood plasma|serum]] prolactin. In the best medical centers, surgery corrects prolactin levels in 80% of patients with a serum prolactin less than 250 ng/ml. Even in patients with large tumors that cannot be completely removed, drug therapy may be able to return serum prolactin to the normal range after surgery. Depending on the size of the tumor and how much of it is removed, studies show that 20 to 50% will recur, usually within five years.
| | ==[[Prolactinoma causes|Causes]]== |
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| Because the results of surgery are so dependent on the skill and knowledge of the [[neurosurgeon]], a patient should ask the surgeon about the number of operations he or she has performed to remove pituitary tumors, and for success and complication rates in comparison to major medical centers. The best results come from surgeons who have performed many hundreds or even thousands of such operations.
| | ==[[Prolactinoma differential diagnosis|Differentiating Prolactinoma from other Diseases]]== |
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| ==[[Prolactinoma natural history, complications, and prognosis|Natural history, Complications, and Prognosis]]== | | ==[[Prolactinoma epidemiology and demographics|Epidemiology and Demographics]]== |
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| == Pregnancy and Oral Contraceptives == | | ==[[Prolactinoma risk factors|Risk Factors]]== |
| If a woman has a small prolactinoma, there is no reason that she cannot conceive and have a normal pregnancy after successful medical therapy. The pituitary enlarges and prolactin production increases during normal pregnancy in women without pituitary disorders. Women with prolactin-secreting tumors may experience further pituitary enlargement and must be closely monitored during pregnancy. However, damage to the pituitary or eye nerves occurs in less than one percent of pregnant women with prolactinoma. In women with large tumors, the risk of damage to the pituitary or eye nerves is greater, and some doctors consider it as high as 25%. If a woman has completed a successful pregnancy, the chances of her completing further successful pregnancies are extremely high.
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| A woman with a prolactinoma should discuss her plans to conceive with her physician, so she can be carefully evaluated prior to becoming pregnant. This evaluation will include a magnetic resonance imaging (MRI) scan to assess the size of the tumor and an eye examination with measurement of visual fields. As soon as a patient is pregnant, her doctor will usually advise that she stop taking bromocriptine or cabergoline, the common treatments for prolactinoma. Most endocrinologists see patients every two months throughout the pregnancy. The patient should consult her endocrinologist promptly if she develops symptoms--particularly headaches, visual changes, nausea, vomiting, excessive thirst or urination, or extreme lethargy. Bromocriptine or cabergoline treatment may be renewed and additional treatment may be required if the patient develops symptoms from growth of the tumor during pregnancy.
| | ==[[Prolactinoma Screening|Screening]]== |
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| At one time, oral contraceptives were thought to contribute to the development of prolactinomas. However, this is no longer thought to be true. Patients with prolactinoma treated with bromocriptine or cabergoline may also take oral contraceptives. Similarly, post-menopausal estrogen replacement is safe in patients with prolactinoma treated with medical therapy or surgery.
| | ==[[Prolactinoma natural history, complications, and prognosis|Natural History, Complications and Prognosis]]== |
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| == Osteoporosis Risk == | | ==Diagnosis== |
| [[Hyperprolactinemia]] can cause reduced [[estrogen]] production in women and reduced [[testosterone]] production in men. Although estrogen/testosterone production may be restored after treatment for hyperprolactinemia, even a year or two without estrogen/testosterone can compromise bone strength, and patients should protect themselves from osteoporosis by increasing exercise and [[calcium]] intake through diet or supplementation, and by avoiding smoking. Patients may want to have bone density measurements to assess the effect of estrogen/testosterone deficiency on bone density. They may also want to discuss testosterone/estrogen replacement therapy with their physician.
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| == Prognosis ==
| | [[Prolactinoma history and symptoms|History and Symptoms ]] | [[ Prolactinoma physical examination|Physical Examination]] | [[Prolactinoma laboratory tests|Laboratory Findings]] | [[Prolactinoma ECG|ECG]] | [[Prolactinoma X-ray|X-ray]]| [[Prolactinoma ultrasound|Ultrasound]] | [[Prolactinoma CT|CT]] | [[Prolactinoma MRI|MRI]] | [[Prolactinoma other imaging findings|Other Imaging Findings]] | [[Prolactinoma other diagnostic studies|Other Diagnostic Studies]] |
| People with microprolactinoma generally have an excellent prognosis. In 95% of cases the tumor will not show any signs of growth after a 4 to 6 year period.
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| Macroprolactinomas often require more aggressive treatment otherwise they may continue to grow. There is no way to reliably predict the rate of growth, as it is different for every individual. Regular monitoring by a specialist to detect any major changes in the tumor is recommended.
| | ==Treatment== |
| | [[Prolactinoma medical therapy|Medical Therapy]] | [[Prolactinoma surgery |Surgery]] |[[Prolactinoma primary prevention |Primary prevention]] |[[Prolactinoma secondary prevention |Secondary prevention]] | [[Prolactinoma cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Prolactinoma future or investigational therapies|Future or Investigational Therapies]] |
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| == References == | | ==Case Studies== |
| Adapted from '''Prolactinoma'''. U. S. National Institutes of Health Publication No. 02-3924 June 2002. [http://www.niddk.nih.gov/health/endo/pubs/prolact/prolact.htm Public Domain Source]
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| ==External links==
| | [[Prolactinoma case study one|Case #1]] |
| *[http://www.pituitary.com/disorders/prolactinomas.aspx Pituitary Network Association]
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| *[http://www.pituitary.org.uk/resources/prolactinoma.htm The Pituitary Foundation]
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| *[http://www.endocrine.niddk.nih.gov/ Endocrine and Metabolic Diseases Information Service]
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| {{Epithelial neoplasms}} | | {{Epithelial neoplasms}} |
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| [[de:Prolaktinom]]
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| [[Category:Disease]] | | [[Category:Disease]] |
| [[Category:Neuroendocrinology]] | | [[Category:Neuroendocrinology]] |
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