Prolactinoma

Prolactinoma is a type of benign pituitary adenoma. This tumor is formed from cells that secret prolactin (a hormone of lactation), and is the most common tumor in young women.

Small prolactinoma (mikroprolactinoma) has a tiny size, defined as one centimeter a small adenoma, but it may be bigger in size – macroprolactinoma.

Prolactinoma also happens in men.

Symptoms depend on the size of the tumor and extent of local pressure on surrounding organs. The most frequent symptoms – headaches and blurred vision – often double vision (diplopia) due to pressure on the optic nerve. Aggressive cases adenomas cause pressure on the cavernous sinus, or wedge-shaped sinuses. As a result, symptoms of neurological deficit.
Symptoms associated with the secretion of prolactin include galactorrhea (the milk from the mammary gland), hypogonadism (functional failure of testicular function in men). The main reason is the low level of the hormone gonadotropin and sex hormones – estrogen and testosterone. This all leads to erectile dysfunction, menstrual problems or termination of the cycle (amenorrhea), infertility, male menopause (andropause) and often gynecomastia in men.

Diagnostics
In the diagnosis of prolactinoma must perform magnetic resonance imaging (MRI) of the brain, and it is recommended to check the level of hormones of the pituitary and adrenal glands, thyroid, growth hormone, cortisol and gonadotropin.

In most cases, large prolactinomas doctor recommends you to check the field of view (if there is pressure on the optic nerve), as well as in cases of prolonged exposure of the reproductive glands, we recommend you get tested for bone density.
Prolactin levels are usually in direct proportion to the size of the tumor. Prolactin levels may be increased under the influence of drugs, especially antipsychotics (neuroleptics), oral estrogen and Pramina.
Prolactin may also be increased in the case of inhibition of the function of the thyroid gland (hypothyroidism). Therefore, prolactin can be adjusted and brought back to normal as a result of the treatment of thyroid problems.
 

Management
Prolactinoma treatment is almost always medication, except a very aggressive form of adenoma, when there is no response to medications, serious side effects or complications (apoplexy), ie, if adenoma necrosis occurs only frequent headache may be recommended surgery and removal of the tumor by transnasal (TSS, transsphenoidal surgery).

For the treatment of adenomas can also be administered dopamine agonists which inhibit prolactin.

Cabergoline is a common, which is assigned to be taken one or two times a week. It gives little side effects which are mainly in lowering blood pressure and nausea. Symptoms usually disappear with the discontinuation of the drug. In high doses, the drug can damage the heart valves, particularly the tricuspid failure, mitral valve, and in these cases it is advisable to perform periodic monitoring with MRI and echocardiography.

Treatment for other drug Parilac (bromocriptine) includes daily administration and a greater number of side effects. In cases of women attempting to conceive a child, drug bromocriptine is considered more often as it has a lower teratogenicity compared with cabergoline.

Special situations affecting the course of management include the following:
♦ Women who want to get pregnant and symptoms of prolactinomas do not bother them, as well as women after menstruation, do not require treatment. Most adenomas have a tiny size and can only be monitored.
♦ Women with high levels of prolactin and asymptomatic prolactinoma on the background of psychiatric treatment can be treated with estrogen and progesterone tablets to preserve the uterus and bone cloth.
♦ Women with small adenoma, whose pregnancy is detected, can stop the medication. In cases of large adenomas it is recommended to continue treatment, to avoid the risk of apoplexy.

Prognosis
Drug therapy prolactinoma is very effective for reducing the size of the tumor, and the correction in prolactin levels. Prolactin levels decreased to normal fairly quickly after starting treatment.