Prolactinoma overview

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Overview

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Pathophysiology

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Differentiating Prolactinoma from other Diseases

Epidemiology and Demographics

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Natural History, Complications and Prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]

Overview

A prolactinoma is a benign tumor (adenoma) of the pituitary gland that produces prolactin. It is the most common type of pituitary tumor. Symptoms of prolactinoma are caused either by hyperprolactinemia or by pressure of the tumor on surrounding tissues. In women, these adenomas are often small (<10 mm). In either sex, however, they can become large enough to enlarge the sella turcica. These adenomas represent the most common hormone-producing pituitary tumors and account for 25% to 41% of tumor specimens.[1] MRI is the most sensitive diagnostic test for detecting pituitary tumors (including prolactinoma). Medical therapy for prolactinoma includes dopamine agonists. Surgery is indicated in patients if medical therapy cannot be tolerated. Transsphenoidal resection of tumor is usually done among patients with prolactinoma.

Historical Perspective

Pituitary tumors were first described by Pierre Marie, a French neurologist.

Classification

Prolactinoma can be classified based upon either size or local invasion. Based on size, a prolactinoma can be classified as a microprolactinoma (<10 mm diameter) or macroprolactinoma (>10 mm diameter).

Pathophysiology

Prolactinoma may occur as part of a hereditary disorder called multiple endocrine neoplasia type 1 (MEN 1). A minority of prolactinomas are associated with multiple endocrine neoplasia type I (MEN I), Carney complex, McCune-Albright Syndrome, MEN like syndrome (CKDN1B loss of function).[2]

Causes

There are no established causes for proloactinoma. The majority of pituitary tumors are sporadic, but a minority of tumors are associated with familial syndromes.

Epidemiology and Demographics

The prevalence of prolactinoma in younger age group is 100 per 100,000 individuals.[3] Pituitary tumors affect approximately 14 out of 100,000 people in United States.

Risk Factors

Common risk factors for the development of prolactinoma include multiple endocrine neoplasia type 1 (MEN 1), Carney complex and McCune-Albright syndrome.

Differentiating prolactinoma from other diseases

Prolactinoma must be differentiated from other causes of hyperprolactinemia such as hypothyroidism, antipsychotics and antidepressants.

Natural History, Complications and Prognosis

If left untreated, 95% of patients with prolactinoma will not show any signs of growth after a 4 to 6 year period. Prognosis is excellent for microprolactinoma. Common complications of prolactinoma include intracranial hemorrhage, osteoporosis and vision loss.

History and Symptoms

Symptoms of prolactinoma include loss of libido, headache, infertility and vision changes.

Physical Examination

Common physical examination findings of prolactinoma include papilledema, visual field defects, cranial nerve palsies.

Laboratory Findings

Laboratory findings consistent with the diagnosis of prolactinoma include elevated prolactin levels and reduced thyroid hormone levels.

CT Scan

On head CT scan, prolactinoma is characterized by enlargement of the pituitary gland.

MRI

MRI may be diagnostic of prolactinoma. Magnetic resonance imaging (MRI) is the most sensitive test for detection of pituitary tumors and determination of their size.

Medical Therapy

Medical therapy for prolactinoma includes dopamine agonists. The goal of treatment is to return prolactin secretion to normal, reduce tumor size, correct any visual abnormalities and restore normal pituitary function.

Surgery

Surgery is indicated in patients if medical therapy cannot be tolerated or if it fails to reduce prolactin levels, restore normal reproduction and pituitary function, and reduce tumor size.

References

  1. http://www.cancer.gov/types/pituitary/hp/pituitary-treatment-pdq#link/_169_toc
  2. http://radiopaedia.org/articles/pituitary-adenoma
  3. Ciccarelli A, Daly AF, Beckers A (2005). "The epidemiology of prolactinomas". Pituitary. 8 (1): 3–6. doi:10.1007/s11102-005-5079-0. PMID 16411062.


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