Prolactinoma occurs when a benign tumor, called an adenoma, affects the pituitary gland located at the base of the brain. The pituitary gland regulates your body’s hormone production and influences blood pressure, growth, and the reproductive systems.
The tumor results in the overproduction of the hormone prolactin, and for women, excessive prolactin causes the suppression of estrogen. Prolactinoma in men results in a reduction in testosterone.
Most cases affect women in their 20s and early 30s, but the condition can occur at any age. Prolactinoma isn’t cancerous, but it can cause unpleasant symptoms. With proper treatment, many of these symptoms can be effectively managed.
Symptoms of Prolactinoma
An excess of prolactin in the bloodstream can cause sexual and hormonal problems. A prolactinoma affects the reproductive systems of both sexes by decreasing the level of sex hormones. For women, this causes symptoms such as:
- Irregular periods or no periods (amenorrhea)
- Increase or thickening of body hair and facial hair
- Cloudy white discharge from the nipples, unrelated to pregnancy or breastfeeding
- Vaginal dryness
- Painful sexual intercourse
- Decreased desire for sex
- Low bone density, osteopenia, or osteoporosis
Additionally, the pressure of a large tumor in the brain, even when it is benign, can cause uncomfortable symptoms such as:
- Vision problems
Usually, women tend to notice the hormone-related symptoms before they experience headaches and vision problems. This is because the tumor will affect the function of the pituitary gland first, and then press on the surrounding brain tissue later as it grows larger.
Other Causes of Prolactinoma
Although most cases of prolactinoma are caused by a tumor on the pituitary gland, there are other conditions that could lead to an overproduction of prolactin and result in the same symptoms. Such conditions include:
- Certain medications
- Trauma to the chest
Complications of Prolactinoma
If left untreated, a prolactinoma can cause more serious health problems. Prolactin floods the bloodstream, reducing estrogen and causing reproductive problems. As the adenoma grows, it can threaten the surrounding tissues.
Estrogen helps bones stay strong. As estrogen leaves the bloodstream, bone density can decrease, leading to bone loss and osteoporosis.
The pituitary gland controls many other hormones aside from prolactin. As the tumor grows, other endocrine functions may start to fail, causing growth hormone deficiency, adrenal insufficiency, and hypothyroidism.
The high levels of estrogen associated with pregnancy may stimulate growth of the prolactinoma, putting pressure on the brain tissue and causing vision problems and headaches.
A prolactinoma may grow large enough to block the optic nerve, leading to a loss of vision.
If you believe you have a prolactinoma, make an appointment with your gynecologist. Keep a log of your menstrual cycle, the details of any symptoms, and when you began to experience these symptoms.
Your doctor will conduct a physical exam and take a blood test to look for an excess of prolactin. An MRI can usually detect a tumor on the pituitary gland. Your doctor may also test your vision for any impairment. Women in their reproductive years may be given a pregnancy test.
If you are pregnant or trying to get pregnant, let your gynecologist know. Your pregnancy may aggravate your prolactinoma.
Treatments for prolactinoma aim to restore the normal function of the pituitary gland and reduce the size of the benign tumor. If treatment is successful, this should decrease the production of prolactin back to normal levels and relieve associated symptoms.
If your gynecologist believes you have a prolactinoma, it’s likely that he or she will refer you to an endocrinologist for treatment. Treatment typically includes one or two primary methods – medication and surgery.
Dopamine agonists are drugs that mimic dopamine and they can help regulate the production of prolactin, restore fertility, and reduce the size of an adenoma. Cabergoline and bromocriptine are two popular choices. Cabergoline seems to be a more effective treatment, but bromocriptine is typically the best choice for women who wish to become pregnant.
If you do become pregnant, your specialist will probably take you off the medication. The long-term effects of these drugs on pregnancy are not yet well-understood.
The side effects of dopamine agonists include:
- Nasal congestion
Surgery is usually only an option after medication is found to be ineffective. Removal of the tumor can decrease the pressure on the surrounding brain tissue and can help restore normal levels of prolactin in the bloodstream, but this is usually only a temporary fix, especially if the tumor was large. Many tumors return in about five years. Surgery in combination with medication can be more effective in regulating hormone levels.
If you believe you are experiencing symptoms of, or suffering from Prolactinoma, or have questions about it, please see your doctor.
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