Prolactinoma – Diagnosis and Treatment
Diagnosis
When a person shows possible signs of a prolactinoma, healthcare providers usually begin by checking hormone levels with blood tests. Elevated prolactin levels may suggest a prolactinoma or another cause of hyperprolactinemia.
Blood tests can also measure other hormones controlled by the pituitary gland to check for imbalances. For women of childbearing age, a pregnancy test is often included.
Doctors use brain imaging to find and measure pituitary tumors. An MRI scan provides clear images of microprolactinomas (small tumors) and macroprolactinomas (larger masses).
Providers may conduct vision tests, like assessing visual fields, if a macroprolactinoma could affect eyesight.
Additional Details
An endocrinologist may perform more thorough hormone evaluations. The size of the benign tumor and its effects on nearby structures, such as vision, are key factors in the diagnosis and management.
Treatment
Medicines Used to Lower Prolactin
Doctors usually start treating prolactinoma with medicines called dopamine stimulants. These medications boost dopamine activity, which helps slow down or stop the body’s extra prolactin production.
Over time, this often shrinks the tumor and can return prolactin levels to a healthier range.
Two commonly used dopamine agonists may help manage certain hormone-related conditions. These medications work by lowering prolactin levels in the body. In some cases, they are used long-term under medical supervision.
While several options exist globally, specific availability and usage may vary by country. Patients should consult their healthcare provider to determine the most appropriate and safe treatment plan.
This helps manage symptoms and can, for many, completely improve menstrual periods, sexual interest, and even fertility.
Doctors check prolactin levels often. If a person’s prolactin stays normal for a couple of years and the tumor has shrunk enough, a provider might let them slowly stop the medicine.
Providers monitor this process closely, as the prolactin levels can rise again for some people, and may restart the medicine if needed.
In some situations, doctors may consider using somatostatin analogs, though these are typically not first-line treatment options. Their use depends on the individual’s condition and response to other therapies.
Usual Drug Side Effects
Most people tolerate dopamine stimulants well, but side effects can happen. Common problems include:
- Nausea or vomiting
- Feeling dizzy or faint
- Stuffy nose
- Headaches
Starting medicine at a low dose and increasing it slowly usually makes these side effects milder. Taking medicine with food or at bedtime may also help reduce discomfort.
Rarely, people may have heart valve changes when taking cabergoline, but this is much more common in people using higher doses for other health conditions, not prolactinoma.
A small number of patients develop impulse control problems, such as urges to gamble. Patients should report any troubling new symptoms to a doctor.
Managing Side Effects
- Start with a low dose.
- Increase the dose slowly if needed.
- Take with food.
- Take before bed to ease stomach upset.
Possible Side Effects Table
| Side Effect | How To Manage |
|---|---|
| Nausea | Take medicine with food or at night. |
| Dizziness | Stand up slowly. |
| Stuffy nose | Usually goes away. |
| Headaches | Adjust dose or timing. |
| Impulse issues | Tell your doctor. |
Treatment with Medicine During Pregnancy
When someone with a prolactinoma wishes to become pregnant, doctors may use dopamine agonists to help normalize prolactin levels and improve fertility.
Each option within this drug class has specific benefits and potential side effects, so it’s important to work with a healthcare provider to determine the most appropriate choice based on individual needs and medical history.
Once pregnancy is confirmed, a provider usually recommends stopping the medicine. Both drugs are generally thought to be safe during pregnancy, but most doctors like to avoid medications when possible for safety.
If the tumor is large or if symptoms (like new headaches or vision problems) appear during pregnancy, doctors may restart medicine to help prevent problems linked to tumor growth.
Anyone thinking about pregnancy should have a detailed talk with their provider to make sure both their health and the health of the future baby are protected.
Surgery to Remove the Tumor
Doctors consider surgery if medicines do not work, cause bad side effects, or when the tumor is large and pressing on nearby nerves, especially those related to vision.
Surgeons most commonly perform trans-sphenoidal surgery, removing the tumor through the nose and the base of the skull, so there are no noticeable scars. This surgery has a good safety track record and usually does not disturb the rest of the brain.
If the tumor is very large or has spread close to or into surrounding brain areas, a surgeon might perform a transcranial operation (through the upper skull). This approach is less common and is only chosen if the safer nasal route is not possible.
The tumor’s size, its location, prolactin levels before surgery, and the experience of the doctor all influence the success of surgery. Surgeons are more likely to cure smaller tumors.
Larger tumors may only be partly removed, so doctors may still prescribe medicines after surgery.
Types of Surgery Table
| Surgery Type | How It’s Done | When It’s Used |
|---|---|---|
| Trans-sphenoidal | Through the nose | Most common, smaller tumors |
| Transcranial | Through the skull, upper head | Large or hard-to-reach tumors |
Using Radiation to Treat Prolactinoma
Doctors rarely use radiation treatments but may consider them when medicines and surgery do not work well enough, or if surgery is not possible. Radiation works by damaging the tumor’s cells so they can’t grow.
The process is generally slow and may take months to years to fully lower prolactin levels.
Providers deliver radiation in different ways and use it carefully because it may harm healthy tissues near the tumor, with possible lasting effects on the pituitary gland.
Getting Ready for Your Visit
Steps to Take Before You Go
It helps to come prepared for your visit with a health care provider, especially if you might see an endocrinologist who specializes in hormone-related conditions. Making notes ahead of time can help you remember important details and questions.
Checklist:
| Information to Bring | Details to Consider |
|---|---|
| Symptoms | All, even if they seem unrelated |
| Menstrual history | Age started, missed cycles, birth control use |
| Personal background | Stresses or recent changes in your life |
| List of medicines and supplements | Include dosages of all pills and tablets |
| Questions for your provider | Write them down so you don’t forget |
Questions you might want to ask:
- What could be causing these symptoms?
- Are there other causes I should know about?
- What tests do you suggest, and do I need to do anything before them?
- What are my treatment options, and which one do you prefer?
- What are the side effects of each treatment?
- If surgery is needed, could the problem return later?
- How can I handle my other health conditions along with this one?
- Will having this problem affect my chances of having children?
- Is there a generic version of the medicine prescribed?
- Do you have booklets or reliable website suggestions for more reading?
It’s also good to note anything else you are concerned about to talk over during your visit. Writing these things down or having them on your phone can make the appointment easier and help you remember everything.
What Your Health Care Provider May Ask
The provider will want to get a clear picture of your symptoms and background. Getting ready for questions can help you give complete answers, which will make the visit more helpful.
Common Questions:
- When did you first notice these symptoms?
- Are your symptoms steady, or do they come and go?
- Is there anything that makes your symptoms better?
- What makes your symptoms worse?
- Has anyone in your family had problems with hormone glands, high calcium, or kidney stones?
Being ready to talk about your health history, family history, and any changes you’ve noticed can help your provider figure out next steps. This will also help the provider decide if you may need to see an endocrinologist, or if other tests are needed.
Bringing documents, such as recent test results or health summaries, can also be useful and help save time during your visit.
More Details
A prolactinoma is a noncancerous tumor found in the pituitary gland that causes too much of the hormone prolactin to be released.
When prolactin levels are high, it can lead to symptoms such as headaches, vision changes, and changes in menstrual periods like missed or irregular cycles (amenorrhea) in women.
Some people develop galactorrhea, which is unusual milk production not linked to childbirth or breastfeeding. Men may notice erectile dysfunction, lower testosterone levels, infertility, less interest in sex, and sometimes breast growth.
Women can also have reduced estrogen levels, vaginal dryness, and problems with bone strength like osteoporosis if not treated.
Symptoms sometimes include dizziness, nausea, or feelings of depression. Both men and women may notice changes in their sex hormones, affecting how their body feels and works.
Less common symptoms are related to reduced pituitary function, like problems with growth hormone that can lead to conditions such as acromegaly or signs of hypothyroidism.
Main symptoms and effects can be grouped in this table:
| Symptom | Possible Effect |
|---|---|
| Headache | Pain or pressure in the head |
| Amenorrhea | Irregular or missed menstrual periods |
| Galactorrhea | Milk discharge not related to childbirth |
| Erectile Dysfunction | Difficulty maintaining an erection |
| Infertility | Problems becoming pregnant or fathering a child |
| Osteoporosis | Weak, brittle bones |
| Nausea or Dizziness | Feeling sick or lightheaded |
| Reduced Sex Drive | Less interest in sexual activity |
| Vaginal Dryness | Discomfort during sex |
| Depression | Low mood, sadness |
Healthcare provides guidance on monitoring symptoms and handling changes in hormone levels. Regular check-ups and treatment help manage symptoms, improve quality of life, and restore healthy pituitary function.
