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==Overview==
==Overview==
A '''prolactinoma''' is a [[benign]] [[tumor]] ([[adenoma]]) of the '''[[pituitary gland]]''' that produces a [[hormone]] called [[prolactin]]. It is the most common type of [[pituitary tumor]].  Symptoms of prolactinoma are caused by too much prolactin in the blood ([[hyperprolactinemia]]) or by pressure of the tumor on surrounding tissues.]
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.
== Pregnancy and Oral Contraceptives ==
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.


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.
==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.<ref name="pmid15191331">{{cite journal| author=Liu JK, Couldwell WT| title=Contemporary management of prolactinomas. | journal=Neurosurg Focus | year= 2004 | volume= 16 | issue= 4 | pages= E2 | pmid=15191331 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15191331  }} </ref>


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.
==Complications==
== Osteoporosis Risk ==
Complications of [[prolactinoma]] include:
[[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.
*[[Pituitary apoplexy]]<ref name="pmid15191331">{{cite journal| author=Liu JK, Couldwell WT| title=Contemporary management of prolactinomas. | journal=Neurosurg Focus | year= 2004 | volume= 16 | issue= 4 | pages= E2 | pmid=15191331 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15191331  }} </ref>
== Prognosis ==
** [[Pituitary apoplexy]] usually presents with  sudden onset of excruciating [[headache]], [[diplopia]], and [[visual impairment]].
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.
** [[Headache]] is most common [[symptom]] and is usually associated with [[nausea]] and [[vomiting]].


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.
{{Family tree/start}}
{{Family tree | | | | A01 | | | |A01= Hemorrhage and/or infarction in prolactinoma}}
{{Family tree | | | | |!| | | | | }}
{{Family tree | | | | B01 | | | |B01= Rapid enlargement of tumor}}
{{Family tree | | | | |!| | | | | }}
{{Family tree | | | | C01 | | | |C01= Compression of sella and para sellar structures}}
{{Family tree/end}}


== References ==
*[[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.<ref>http://www.niddk.nih.gov/health-information/health-topics/endocrine/prolactinoma/Pages/fact-sheet.aspx</ref>


==References==
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Latest revision as of 23:49, 29 July 2020

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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.[1]

Complications

Complications of prolactinoma include:

 
 
 
Hemorrhage and/or infarction in prolactinoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rapid enlargement of tumor
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Compression of sella and para sellar structures
 
 
 

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.[2]

References

  1. ↑ 1.0 1.1 Liu JK, Couldwell WT (2004). "Contemporary management of prolactinomas". Neurosurg Focus. 16 (4): E2. PMID 15191331.
  2. ↑ http://www.niddk.nih.gov/health-information/health-topics/endocrine/prolactinoma/Pages/fact-sheet.aspx

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