Prolactinoma overview: Difference between revisions

Jump to navigation Jump to search
m (Bot: Removing from Primary care)
 
(139 intermediate revisions by 10 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Prolactinoma}}
{{Prolactinoma}}
{{CMG}}
{{CMG}}; {{AE}} {{Anmol}}, {{Faizan}}
==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.
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 45% of all [[pituitary tumors]]. [[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 the tumor is rarely done among patients with [[prolactinoma]] as most of the patients respond to medical management.
Prolactin stimulates the [[breast]] to produce milk during [[pregnancy]]. After delivery of the baby, a mother's prolactin levels fall unless she breast feeds her infant. Each time the baby nurses, prolactin levels rise to maintain milk production.
 
==Historical Perspective==
 
In 1970, [[prolactin]] was discovered in humans by sensitive [[bioassay]]. In 1978, V C Medvei, the President of the Section of History of Medicine (1986-87) of the Royal Society of Medicine in London, wrote in his paper that Queen Mary I of England was believed to have prolactinoma.
 
==Classification==
==Classification==
Based on size, a prolactinoma can be classified as a ''microprolactinoma'' (<10 mm diameter) or ''macroprolactinoma'' (>10 mm diameter).
[[Prolactinoma]] can be classified based either on size or local invasion. Based on size, a prolactinoma can be classified as a microprolactinoma (<10 mm diameter) or macroprolactinoma (>10 mm diameter).
==Prolactinoma and Pregnancy==
 
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%.
==Pathophysiology==
[[Prolactinoma]] is the most common type of [[pituitary adenoma]]. [[Prolactinoma]] may occur in approximately 30% of [[multiple endocrine neoplasia type 1]] patients. It may also occur with [[Carney complex]] or [[McCune-Albright syndrome]]. There are a few reports of [[familial]] cases of [[prolactinoma]] unrelated to [[Multiple endocrine neoplasia type 1|MEN 1 syndrome]]. [[Prolactinoma]] is also associated with various [[familial]] syndromes. On gross pathology, [[prolactinoma]] is divided on the basis of size into microprolactinoma and macroprolactinoma. On [[histological]] analysis, [[prolactinoma]] may be divided into sparsely granulated and densely granulated prolactinomas.
 
==Causes==
==Causes==
It has been shown that stress can significantly raise [[prolactin]] levels which should make stress a diagnostic differential though it usually is not considered such. Most [[pituitary]] tumors are sporadic--they are not genetically passed from parents to offspring.
There are no established causes for [[prolactinoma]]. Most cases of [[prolactinoma]] are sporadic. [[Prolactinoma]] may occur in approximately 30% of [[multiple endocrine neoplasia type 1]] patients. It may also occur with [[Carney complex]] or [[McCune-Albright syndrome]].
 
== Differentiating prolactinoma from other diseases ==
[[Prolactinoma]] must be differentiated from other causes of [[hyperprolactinemia]] that may also present as [[galactorrhea]], [[amenorrhea]], (in females) and [[infertility]] (in both males and females). Causes of [[hyperprolactinemia]] can be categorized as [[physiological]], [[pathological]], and [[medication-induced]].
 
==Epidemiology and Demographics==
==Epidemiology and Demographics==
[[Autopsy]] studies indicate that 6-25% of the U. S. population have small pituitary tumors. Forty percent of these pituitary tumors produce prolactin, but most are not considered clinically significant. Clinically significant pituitary tumors affect the health of approximately 14 out of 100,000 people in United States.
45% of [[Pituitary adenoma|pituitary adenomas]] are [[prolactinomas]], making it the most common type of all [[Pituitary adenoma|pituitary adenomas]]. Worldwide, the prevalence of sporadic [[prolactinoma]] is 6 to 10 per 100,000 persons. The prevalence of [[prolactinoma]] in people less than 20 years old is 10 per 100,000 individuals worldwide. [[Prolactinoma]] most commonly affects women in reproductive age group (20 to 50 years). [[Prolactinoma]] is more common in females than males in people between 20 and 50 years old. Frequency becomes similar after age 50.
==Differentiating prolactinoma from other diseases==


Hyperprolactinemia caused by prolactinoma must be differentiated from medications(antipsychotics and antidepressants) and hypothyroidism.
==Risk Factors==
There are no established risk factors for [[prolactinoma]]. Some conditions increase the risk of [[prolactinoma]], such as [[multiple endocrine neoplasia type 1]] ([[MEN 1]]), [[Carney complex]], [[McCune-Albright Syndrome|McCune-Albright syndrome]], familial isolated [[pituitary adenoma]], and MEN 1 like [[syndrome]].
 
== Screening ==
There is insufficient evidence to recommend routine [[Screening (medicine)|screening]] for [[prolactinoma]].


==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==
 
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.
[[Hyperprolactinemia]] can cause reduced [[estrogen]] production in women and reduced [[testosterone]] production in men.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. 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.


==History and Symptoms==
==History and Symptoms==
Common [[symptoms]] of [[prolactinoma]] include [[headache]], vision changes, decreased [[libido]], [[infertility]], and [[osteoporosis]]. In women, common [[symptoms]] of [[prolactinoma]] include [[breast]] tenderness, [[galactorrhea]], and [[amenorrhea]] or [[oligomenorrhea]].


The symptoms experienced by women and men are as for [[hyperprolactinemia]] from all causes.
==Physical Examination==
Patients with [[prolactinoma]] generally appear healthy. The most common [[physical examination]] finding of [[prolactinoma]] is [[visual field]] defects ([[bitemporal hemianopsia]]).


==Physical Examination==
==Laboratory Findings==
Laboratory findings consistent with the diagnosis of [[prolactinoma]] include markedly elevated [[prolactin]] levels.


In addition to assessing the size of the pituitary tumor and damage to surrounding tissues it is necessary to perform tests to assess whether production of other pituitary hormones is normal. Depending on the size of the tumor, the physician may request an eye exam with measurement of visual fields.
==ECG==
There are no [[ECG]] findings associated with [[prolactinoma]].


==Laboratory Findings==
==X-ray==
There are no [[X-ray]] findings associated with [[prolactinoma]].


Prolactin blood levels are tested in women with unexplained milk secretion ([[galactorrhea]]) or irregular [[menses]] or [[infertility]], and in men with impaired sexual function and, in rare cases, milk secretion.
==Ultrasound==
There are no [[ultrasound]] findings associated with [[prolactinoma]].  


==CT Scan==
==CT Scan==
[[CT scan]] of head is usually normal in patient of [[prolactinoma]]. Sometimes, enlargement of [[sella turcica]] may be found in case of macroprolactinoma.
==MRI==
==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==
Medical therapy for prolactinoma includes [[dopamine agonists]] (either [[cabergoline]] or [[bromocriptine]]). 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==
Surgery is not the first-line treatment option for patients with [[prolactinoma]]. [[Surgery]] is usually reserved for patients whose medical therapy fails to reduce the size of the [[tumor]].
==Primary prevention==
There is no established method for [[primary prevention]] of [[prolactinoma]].
==Secondary prevention==
There is no established method for [[secondary prevention]] of [[prolactinoma]].


== References ==
== References ==
Line 43: Line 74:
{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}


[[Category:Disease]]
[[Category:Disease]]
[[Category:Neuroendocrinology]]
[[Category:Neuroendocrinology]]
[[Category:Mature chapter]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Endocrinology]]
[[Category:Up-To-Date]]
[[Category:Neurology]]
[[Category:Neurosurgery]]

Latest revision as of 23:50, 29 July 2020

Prolactinoma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Prolactinoma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

ECG

X-ray

Ultrasound

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Prolactinoma overview On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Prolactinoma overview

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Prolactinoma overview

CDC on Prolactinoma overview

Prolactinoma overview in the news

Blogs on Prolactinoma overview

Directions to Hospitals Treating Prolactinoma

Risk calculators and risk factors for Prolactinoma overview

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

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 45% of all pituitary tumors. 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 the tumor is rarely done among patients with prolactinoma as most of the patients respond to medical management.

Historical Perspective

In 1970, prolactin was discovered in humans by sensitive bioassay. In 1978, V C Medvei, the President of the Section of History of Medicine (1986-87) of the Royal Society of Medicine in London, wrote in his paper that Queen Mary I of England was believed to have prolactinoma.

Classification

Prolactinoma can be classified based either on 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 is the most common type of pituitary adenoma. Prolactinoma may occur in approximately 30% of multiple endocrine neoplasia type 1 patients. It may also occur with Carney complex or McCune-Albright syndrome. There are a few reports of familial cases of prolactinoma unrelated to MEN 1 syndrome. Prolactinoma is also associated with various familial syndromes. On gross pathology, prolactinoma is divided on the basis of size into microprolactinoma and macroprolactinoma. On histological analysis, prolactinoma may be divided into sparsely granulated and densely granulated prolactinomas.

Causes

There are no established causes for prolactinoma. Most cases of prolactinoma are sporadic. Prolactinoma may occur in approximately 30% of multiple endocrine neoplasia type 1 patients. It may also occur with Carney complex or McCune-Albright syndrome.

Differentiating prolactinoma from other diseases

Prolactinoma must be differentiated from other causes of hyperprolactinemia that may also present as galactorrhea, amenorrhea, (in females) and infertility (in both males and females). Causes of hyperprolactinemia can be categorized as physiological, pathological, and medication-induced.

Epidemiology and Demographics

45% of pituitary adenomas are prolactinomas, making it the most common type of all pituitary adenomas. Worldwide, the prevalence of sporadic prolactinoma is 6 to 10 per 100,000 persons. The prevalence of prolactinoma in people less than 20 years old is 10 per 100,000 individuals worldwide. Prolactinoma most commonly affects women in reproductive age group (20 to 50 years). Prolactinoma is more common in females than males in people between 20 and 50 years old. Frequency becomes similar after age 50.

Risk Factors

There are no established risk factors for prolactinoma. Some conditions increase the risk of prolactinoma, such as multiple endocrine neoplasia type 1 (MEN 1), Carney complex, McCune-Albright syndrome, familial isolated pituitary adenoma, and MEN 1 like syndrome.

Screening

There is insufficient evidence to recommend routine screening for prolactinoma.

Natural History, Complications and Prognosis

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.

History and Symptoms

Common symptoms of prolactinoma include headache, vision changes, decreased libido, infertility, and osteoporosis. In women, common symptoms of prolactinoma include breast tenderness, galactorrhea, and amenorrhea or oligomenorrhea.

Physical Examination

Patients with prolactinoma generally appear healthy. The most common physical examination finding of prolactinoma is visual field defects (bitemporal hemianopsia).

Laboratory Findings

Laboratory findings consistent with the diagnosis of prolactinoma include markedly elevated prolactin levels.

ECG

There are no ECG findings associated with prolactinoma.

X-ray

There are no X-ray findings associated with prolactinoma.

Ultrasound

There are no ultrasound findings associated with prolactinoma.

CT Scan

CT scan of head is usually normal in patient of prolactinoma. Sometimes, enlargement of sella turcica may be found in case of macroprolactinoma.

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 (either cabergoline or bromocriptine). 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 not the first-line treatment option for patients with prolactinoma. Surgery is usually reserved for patients whose medical therapy fails to reduce the size of the tumor.

Primary prevention

There is no established method for primary prevention of prolactinoma.

Secondary prevention

There is no established method for secondary prevention of prolactinoma.

References


Template:WikiDoc Sources