Prolactinoma 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: Anmol Pitliya, M.B.B.S. M.D.[2], Faizan Sheraz, M.D. [3]

Overview

If left untreated, 95% of cases of prolactinoma will not show any signs of growth during the first 4 to 6 years. Complications of prolactinoma include pituitary apoplexy and vision loss. Prognosis is generally excellent for cases of microprolactinoma.

Natural History

If left untreated, 95% of cases of prolactinoma will not show any signs of growth during the first 4 to 6 years. Sometimes, it may lead to premature osteoporosis in both sexes due to hyperprolactinomia.

Complications

Complications of prolactinoma include:

• Pituitary apoplexy
  • Pituitary apoplexy usually presents with sudden onset of excruciating headache, diplopia, and visual impairment.
  • Headache is most common symptom and is usually associated with nausea and vomiting.

Hemorrhage and/or infarction in prolactinoma

Rapid enlargement of tumor

Compression of sella and para sellar structures

• Tumor regrowth (after resection)
• Blindness
• In pregnancy, excessive estrogen may cause increased tumor growth

Prognosis

• Prognosis is excellent for cases of microprolactinoma.
• Depending on the size of the tumor and the extent of tumor resection, the rate of recurrence may range from 20% to 50%.
• The majority of recurrent prolactinomas develop within the first 5 years.

References

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