Prolactinoma is a type of pituitary adenoma (or tumor). Several types of pituitary tumors can affect hormone levels, with prolactinoma being the most common type that produces a hormone. It makes up at least 30% of all pituitary adenomas. While prolactinoma is benign, the hormone imbalances caused by the tumor can produce undesirable side effects.
What is a prolactinoma tumor?
Prolactinoma occurs when a benign tumor, called an adenoma, affects the pituitary gland at the brain’s base. The pituitary gland is a hormone-secreting gland that regulates your body’s production of thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), follicle-stimulating hormone (FSH), and luteinizing hormones (LH). These hormones impact various bodily functions and influence blood pressure, growth, and reproductive systems.
As a result of the tumor, levels of some sex hormones, estrogen in women and testosterone in men, often decrease. At the same time, the pituitary tumor results in the overproduction of the hormone prolactin (hyperprolactinemia).
The connection between prolactinoma and estrogen
Prolactin is important in women during pregnancy and postpartum as it stimulates the production of breast milk and the development of mammary glands in the breast tissue for breastfeeding. However, the hormone also has many other functions, such as regulating moods and metabolism throughout a woman’s life. Prolactin levels are usually higher during pregnancy and after childbirth when milk production is needed. A mother’s prolactin levels decrease to normal a few weeks after lactation is discontinued.
But prolactin suppresses estrogen. Low estrogen levels can affect a woman’s menstrual cycle, fertility, libido, sleep, and mood. So, while prolactinoma is benign, it can cause unpleasant symptoms. Most cases of a prolactin-producing tumor affect women in their 20s and early 30s, but the condition can occur at any age.
Symptoms of prolactinoma
An excess of prolactin in the bloodstream can cause sexual and hormonal problems for men and women. Prolactinoma symptoms in women include:
- Irregular menstrual periods or no menstruation (amenorrhea)
- Acne
- 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
- Infertility
- Low bone density, osteopenia, or osteoporosis
- Easy bruising
- High blood sugar levels
In males, symptoms of decreased testosterone levels from prolactinoma often include:
- Erectile dysfunction
- Decreased body and facial hair
- Smaller muscles or muscle weakness
- Enlarged breasts
Additionally, the pressure of a large tumor (macroprolactinomas) in the brain, even when it is benign, can cause uncomfortable symptoms such as:
- Headaches
- Vision changes (double vision, loss of peripheral vision)
Symptoms like missed periods, unexplained milk production and secretion (galactorrhea), or infertility are often the first noticeable signs in younger women with small tumors. Women tend to notice these hormone-related symptoms before they experience headaches and vision problems, especially if they are premenopausal.
Causes of prolactinoma
In most cases, the cause of prolactinoma is unknown. Prolactinoma is also not the only cause of increased levels of prolactin. Other causes for high prolactin that can result in the same symptoms include:
- Pregnancy
- Breastfeeding
- Hypothyroidism
- Certain medications
- Trauma to the chest
Complications of prolactinoma
If left untreated, prolactinoma can cause more serious health problems. Prolactin floods the bloodstream, reducing sex hormones and causing reproductive problems. As the tumor grows, it can threaten the surrounding tissues. Additionally, pituitary adenoma has been linked to Cushing’s Disease and growth hormone-related conditions like acromegaly. If left untreated, prolactinoma can cause the following concerns.
Osteoporosis
Too much prolactin can reduce the production of the hormones estrogen and testosterone, resulting in decreased bone density and an increased risk of osteoporosis.
Hypopituitarism
The pituitary gland controls many other hormones in addition to prolactin. With larger tumors, pressure on the normal pituitary gland can cause dysfunction of other hormones controlled by the pituitary, resulting in hypothyroidism, adrenal insufficiency, and growth hormone deficiency.
Pregnancy-related complications
During a normal pregnancy, the production of estrogen increases. If you are pregnant and have a large prolactinoma, these high levels of estrogen may cause tumor growth and associated signs and symptoms, such as headaches and changes in vision.
Vision loss
A prolactinoma may grow large enough to block the optic nerve, leading to vision loss.
How is prolactinoma diagnosed?
Prolactinoma is often suspected when an individual notices the symptoms. Keeping a log of your menstrual cycle, the details of any symptoms, and when you begin to experience these symptoms can help Dr. Aliabadi make a determination. She will also conduct a physical exam and complete a blood test to look for typical prolactinoma levels of hormones. Additional testing may be needed to rule out other causes of high prolactin levels, such as medications or thyroid concerns. Women in their reproductive years may also be given a pregnancy test.
If a prolactinoma is suspected, imaging tests like magnetic resonance imaging (MRI) can usually detect a tumor and its size on the pituitary gland. Dr. Aliabadi will also look for damage to surrounding tissues and perform tests to assess whether the production of other pituitary hormones is normal. Depending on the size of the tumor, she may request an eye exam with a measurement of visual fields.
Treating prolactinoma
Medical treatments for prolactinoma aim to restore the normal function of the pituitary gland and reduce the size of the tumor. If treatment is successful, this should decrease the production of prolactin back to normal levels and relieve associated symptoms. If medical therapy is effective, women with prolactinoma can usually conceive and have a normal pregnancy. It’s essential to manage even a small prolactinoma (microprolactinoma), as pregnancy can aggravate it and cause enlargement.
If Dr. Aliabadi believes you have a prolactinoma, she will likely have you follow up with an endocrinologist for treatment. Treatment of pituitary tumors often includes medication, surgery, or both. 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. If these prolactinoma drugs do not work, prolactinoma surgery may be needed to remove the tumor from the pituitary gland. However, it is common for large tumors to return even after prolactin tumor surgery, in which case radiation therapy may also be necessary.
Have questions about your health? Talk to Dr. Aliabadi
Dr. Aliabadi isn’t only an expert OB/GYN but knowledgeable in all aspects of women’s health and well-being, including hormonal changes and their potential causes. Dr. Aliabadi and her caring, supportive staff are available to support you through menopause, childbirth, infertility, or even just routine gynecological care.
We invite you to establish care with Dr. Aliabadi. Please make an appointment online or call us at (844) 863-6700.
The practice of Dr. Thais Aliabadi and the Outpatient Hysterectomy Center is conveniently located for patients throughout Southern California and the Los Angeles area. We are near Beverly Hills, West Hollywood, Santa Monica, West Los Angeles, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles.
Prolactinoma FAQs
What are the symptoms of high prolactin levels in females?
High prolactin levels in women can cause irregular or absent menstrual periods, infertility, and menopausal symptoms associated with low estrogen, like hot flashes, low libido, and vaginal dryness. If elevated prolactin and low estrogen go undiagnosed for several years, they can also cause osteoporosis and its associated symptoms.
Is prolactinoma a brain tumor?
A prolactinoma is a type of tumor, but it develops on the pituitary gland, which sits at the base of the brain and not within the brain itself.
What does a prolactinoma headache feel like?
A prolactinoma headache usually feels like an aching pain. It can occur on one or both sides of the forehead and may accompany vision problems.
Sources:
Prolactinoma Management https://www.ncbi.nlm.nih.gov/books/NBK279174
Prolactinoma https://www.ncbi.nlm.nih.gov/books/NBK459347
Physiology, Prolactin https://www.ncbi.nlm.nih.gov/books/NBK507829
Hyperprolactinemia https://www.ncbi.nlm.nih.gov/books/NBK537331
Supported by her warm professional team, Dr. Aliabadi treats women through all phases of life and cherishes the special one-on-one relationship between patient and doctor.
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