Prolactinomas represent approximately 50% of all pituitary adenomas, with a female preponderance.
Women usually present with amenorrhoea and galactorrhoea. Men may present with sexual dysfunction, hypogonadism, and sometimes gynaecomastia, all related to the hyperprolactinaemia.
Premenopausal women present earlier due to menstrual irregularity and hence usually have microprolactinomas. Men and post-menopausal women often present later with macroadenomas, which may be invasive or giant tumours.
Treatment with dopamine agonists usually results in prolactin normalisation, symptom improvement, and tumour shrinkage.
Prolactinomas are benign lactotroph adenomas expressing and secreting prolactin.
History and exam
Key diagnostic factors
- presence of risk factors
- amenorrhoea or oligomenorrhoea
- loss of sexual desire (libido)
- erectile dysfunction
- visual deterioration (e.g., temporal hemianopia)
Other diagnostic factors
- genetic predisposition (e.g., presence of mutation resulting in multiple endocrine neoplasia-1 [MEN-1], familial isolated pituitary adenoma [FIPA])
- oestrogen therapy
- male sex, 30 to 60 years of age
- female sex, 20 to 50 years of age
1st investigations to order
- serum prolactin
- pituitary MRI
- computerised visual-field examination
- Non-functioning pituitary macroadenomas
- Drug-induced hyperprolactinaemia
- Primary hypothyroidism
- Position statement for clinical practice: prolactin-secreting tumors
- Clinical practice guidelines for the management of aggressive pituitary tumours and carcinomas
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