What is Prolactinoma?

A Prolactinoma is a benign (noncancerous and normally non-life-threatening) tumor of the pituitary gland in your brain. The pituitary gland regulates growth along with many other bodily functions. A prolactinoma tumor generates an excessive amount of prolactin, a hormone that supports lactation. In excess, prolactin can potentially cause multiple problematic symptoms and complications in both men and women.

Symptoms

A prolactinoma, itself, may show no signs and symptoms. However, large tumors pressing against surrounding tissue can cause a myriad of complications. Additionally, high levels of the growth-hormone prolactin can disrupt the reproductive system and lead to different Prolactinoma symptoms in both males and females.

Prolactinoma symptoms across gender include:

• Decreased interest in sexual activity
• Decreased hormone production (by the pituitary gland)
• Headaches (known as a prolactinoma headache)
• Infertility
• Low bone density
• Blurry vision or (in extreme cases) even vision loss

Symptoms in women include:

• Pain during intercourse
• Intermittent or no menstrual periods
• Weight gain
• Acne
• Exorbitant growth of body and facial hair
• Milk production from the breasts when not pregnant or breast-feeding

Symptoms in men include:

• Enlarged breasts (rarely)
• Erectile disfunction
• Reduced growth in body and facial hair

Causes

There are no known causes of prolactinoma tumors. More women than men, and even some children, develop prolactinomas. Most prolactinomas are not genetic and carry a low risk of recurrence in families. Since they produce high levels of prolactin, and can vary in size and shape, these tumors can interrupt important body processes such as vision, metabolism and reproduction. Other common causes of increased prolactin levels include pregnancy, breastfeeding, certain medications and other pituitary tumors.

Diagnosis

Diagnosing prolactinoma involves a doctor asking routine questions about your medical history and symptoms followed by a physical examination. Your doctor might also recommend blood tests, brain imaging and vision tests:

• Blood tests: Blood tests can measure the levels of prolactin and other hormones in the bloodstream.
• Pregnancy test: Women are often given a pregnancy test to inform further testing and examination for a prolactinoma.
• Magnetic resonance imaging (MRI): An MRI scans the brain, captures an image of the brain, and sometimes reveals pituitary tumors.
• Vision tests: Vision tests can measure the possible impact of a prolactinoma on your sight.
• Additional tests: Your provider might refer you for more intensive testing by a provider who specializes in the endocrine system.

A prolactinoma diagnosis can certainly be scary. Tumors of any kind can bring up feelings of fear, anxiety, frustration, anger, confusion and sadness. Any feeling response is valid. Remember, though, that a prolactinoma is a benign tumor that is not life-threatening. There is treatment available with low risks and high rates of success. 

Treatment

The two standard prolactinoma treatments are medications and surgery. Oral medications such as bromocriptine and cabergoline can reduce prolactin production and the size of the prolactinoma tumor. Generally, long-term medication treatment is required. Common side effects of medication treatments are nausea and vomiting, nasal stuffiness, headaches and drowsiness.

If a patient does not respond to medication or cannot take the medication due to pregnancy or other health reasons, the next step is surgical treatment. The type of surgery depends on the size, scope, and position of the tumor on the brain. Usually, the Prolactinoma is removed through the nasal cavity. This is a low-risk procedure that leaves no visible scaring. For larger tumors, a surgeon can remove the Prolactinoma through the top of the skull. In cases where medication and surgery do not work or where they are not viable options, radiation treatment is a potential treatment approach.

Complications

Prolactinomas can cause several predictable complications:

• Reduced bone density: High prolactin levels can decrease the manufacture of estrogen and testosterone. These hormones impact bone density and vulnerability to osteoporosis.
• Vision loss: Vision problems are a common symptom of prolactinomas. Undiagnosed or untreated pituitary gland tumors can expand to compress the neighboring optic nerves.
• Tumor growth during pregnancy: High levels of estrogen produced during normal pregnancy can accelerate the growth of prolactinomas. This rapid expansion of the tumor can trigger headaches and vision abnormalities.
• Decreased levels of essential hormones: Increased prolactinoma levels can lower the production of other essential hormones. Reduction in hormones like cortisol can cause weakness, fatigue, and low blood pressure.

Baptist Health is here to help you, or any of your loved ones, who may be experiencing signs and symptoms of prolactinoma.