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What is a prolactinoma? Symptoms and Treatment Methods

Prolactinoma is a non-cancerous tumor of the pituitary gland. This tumor causes the pituitary gland to release too much of a hormone called prolactin. The main effect of prolactinoma is decreased levels of certain sex hormones; Estrogen in women and testosterone in men.What is a prolactinoma?  Symptoms and Treatment Methods
Although prolactinomas are not life-threatening, they can cause vision difficulties, infertility, and other problems. A prolactinoma is the most common type of hormone-producing tumor that can affect your pituitary gland.
Doctors can usually treat prolactinomas with medications to return prolactin to its normal level. Surgery to remove the pituitary tumor is also an option.

What Are the Symptoms of Prolactinoma?

A prolactinoma may not cause any noticeable signs or symptoms. However, hyperprolactinemia, or pressure on surrounding tissue from a large tumor, can cause signs or symptoms. Because high levels of the hormone prolactin can impair the reproductive system (i.e. cause hypogonadism), some of the signs and symptoms of prolactinomas may be different in men or women.
Prolactinomas in women can cause:
• Irregular or intermittent menstruation
• Milky discharge from the breast when you are not pregnant or breastfeeding
• Pain during intercourse due to vaginal dryness
• Acne appearance and increased hair growth on the body and face
Prolactinomas in men can cause:
• Erectile dysfunction
• Decreased hair growth on the body and face
• Breast enlargement, rare
In both sexes, prolactinomas can cause:
• Low bone density
• Decreased secretion of other hormones by the pituitary gland as a result of tumor pressure
• Loss of desire for sexual activity
• Headache
• Visual disturbances
• Infertility
Women usually notice signs and symptoms earlier than men when the tumors are smaller, possibly due to irregular or amenorrhea. In men, they usually notice it later than in women, at which point the tumors are larger and more likely to cause headaches or vision problems.

What Causes Prolactinoma?

Prolactinoma is a type of tumor originating from the pituitary gland. The cause of these tumors is unknown.
The pituitary gland is a small, bean-shaped gland located at the base of the brain. Although the pituitary gland is small in size, it affects almost every part of your body. The hormones they secrete help regulate important functions such as growth, metabolism, blood pressure, and reproduction.
Other possible causes of excessive prolactin production include medications, other pituitary tumors, hypothyroidism, persistent breast irritation, pregnancy and breastfeeding.

What are the Prolactinoma Risk Factors?

Prolactinomas affect women more than men. Rarely, children have this disorder.

What Are the Complications of Prolactinoma?What is a prolactinoma?  Symptoms and Treatment Methods

Prolactinoma complications can include:
• Thinning of the bones (osteoporosis): Excessive prolactin production can lead to decreased production of estrogen and testosterone hormones, resulting in decreased bone density and an increased risk of osteoporosis.
• Pregnancy complications: During a normal pregnancy, the rate of estrogen production increases. If you are pregnant and have a large prolactinoma, high estrogen levels can cause the tumor to enlarge, with associated signs and symptoms such as headaches and vision changes.
• Vision loss: If left untreated, a prolactinoma can grow large enough to put pressure on the optic nerve. This can cause loss of vision.
• Decreased levels of other pituitary hormones: A large prolactinoma puts pressure on the normal pituitary gland, causing low levels of thyroid hormones and other hormones controlled by the pituitary gland, including cortisol (stress response hormone).
Talk to your doctor if you have a prolactinoma and want to become pregnant or are already pregnant. Some adjustments in treatment and follow-up may be required.

How Is a Prolactinoma Diagnosed?

If you have prolactinoma signs and symptoms, your doctor may recommend:
• Blood tests: Blood tests can detect excessive prolactin production and whether other hormones controlled by the pituitary gland are at normal levels. Women of childbearing age are given a pregnancy test.
• Brain imaging: Your doctor can detect a pituitary tumor through an image from an MRI scan of your brain.
• Vision tests: These can determine whether a pituitary tumor has impaired vision.
• Additionally, your doctor may refer you to a doctor who specializes in the treatment of endocrine disorders (endocrinologist) for more extensive testing.

Prolactinoma Treatment Methods

Treatment goals for prolactinoma include:
• Restoring prolactin production to normal levels
• Return of the pituitary gland to its normal function
• Reducing the size of the pituitary tumor
• Elimination of any signs or symptoms of tumor pressure, such as headaches or vision problems
• Improving the quality of life
Prolactinoma treatment consists of two main treatments: medications and surgical treatment.
Medication
Oral medications often work to reduce prolactin production and relieve symptoms. Medications can also shrink the tumor. But long-term treatment with medication is usually necessary.
Doctors use drugs known as dopamine agonists to treat prolactinomas. These drugs mimic the effects of dopamine, the brain chemical that normally controls prolactin production. Commonly available prescription-only medications include bromocriptine and cabergoline. These drugs also reduce prolactin production and can shrink the tumor in most prolactinoma patients.
common side effects
Nausea, vomiting, nasal congestion, headache and drowsiness are common side effects of these drugs. However, these side effects can be minimized if your doctor starts prescribing the drug at very low doses and gradually increases the dose.
There have been rare cases of heart valve damage due to cabergoline use, but this has often occurred in people taking much higher doses for Parkinson’s disease. Some people may also complain of compulsive behavior while taking these drugs.
If the drug has significantly reduced the tumor and the prolactin level has remained normal for two years, you can gradually reduce the dose of the drug under the guidance of your doctor. However, recurrences of the disease are common. Do not stop taking this medicine without your doctor’s approval.
taking medication during pregnancy
Bromocriptine is a drug more commonly used to treat women who want to restore their fertility. However, if you become pregnant, your doctor is likely to recommend that you stop taking this medicine.
Although both drugs are considered safe in early pregnancy, their safety throughout pregnancy is unknown. However, if you have a large prolactinoma or have signs and symptoms such as a headache or vision changes, your doctor may recommend restarting the medication to avoid complications from the prolactinoma.What is a prolactinoma?  Symptoms and Treatment Methods
If you’re being treated for prolactinoma and want to start a family, it’s best to talk to your doctor about your options before getting pregnant.

Surgical treatment

If medication doesn’t work for your prolactinoma or you can’t tolerate medication, surgery to remove the tumor is often an option. Surgery may be needed to reduce pressure on the nerves that control vision.
The type of surgery required depends largely on the size of the tumor and how far it has spread:
• Surgical excision with a wedge: Most people who need surgery have this procedure in which the tumor is removed from the nasal cavity. This procedure is called transsphenoidal excision. Since no other part of the brain is touched during the surgery, the complication rate is low and there is no visible scar in this surgery.
• Brain surgery: If the tumor is large or has spread to nearby brain tissue, you may need this procedure, also known as a craniotomy. The surgeon removes the tumor from the top of the skull.
The outcome of the surgery depends on the size and location of the tumor, the prolactin levels in your body prior to surgery, as well as the skill of the surgeon. The higher the prolactin level, the less chance that prolactin production will return to normal after surgery.
In most people with small pituitary tumors, surgical treatment restores prolactin levels. However, many pituitary tumors return within five years of surgery. For people with larger tumors that can only be partially removed, drug therapy usually leads to normal prolactin levels after surgery.

Radiation Therapy

Radiation therapy may be an option for people who do not respond to treatment and are not candidates for surgery.

Preparing for Your Doctor’s Appointment

You’ll probably start by seeing your family doctor. You may then be referred to a doctor who specializes in disorders that affect the glands and hormones (endocrinologist).
Here is some information to help you prepare for your appointment;
What can you do?
• Write down your symptoms, including any that seem unrelated to the reason you made the appointment.
• For women, write down your menstrual history, the age of onset of your period, your missed period, approximate dates, and the type of birth control method used.
• Write down important personal information, including major stressors or recent life changes.
• Make a list of all the medications, vitamins and supplements you take.
Questions to ask your doctor
Creating a list of questions can help you make the most of your time with your doctor. Some important questions to ask for prolactinoma include:
• What is the most likely cause of these symptoms?
• What are the other possible causes?
• What checks do I need to do? Do these examinations require special preparations?
• What treatments are available and which would you recommend?
• What side effects can I expect as a result of the treatment?
• Would my prolactinoma recur if I had the surgery?
• I have other medical conditions. How can I best manage these situations together?
• Will I be able to have children?
• Is there an alternative medicine of the same type as the medicine you prescribed me?
• Are there brochures or other printed materials I can get? Which websites would you recommend me?
Do not hesitate to ask more questions.
Questions your doctor may ask youWhat is a prolactinoma?  Symptoms and Treatment Methods
Your doctor will likely ask you a number of questions, including:
• When did your symptoms start?
• Are your symptoms persistent or occasional?
• Is there anything that improves your symptoms?
• What, if any, makes your symptoms worse?
• Have you or a family member ever had high calcium levels, kidney stones or endocrine tumors?

Writer: Omer ERIS

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