Prolactinomas represent approximately 50% of all pituitary adenomas, with a female preponderance.
Women usually present with amenorrhea and galactorrhea. Men may present with sexual dysfunction, hypogonadism, and sometimes gynecomastia, all related to the hyperprolactinemia.
Premenopausal women present earlier due to menstrual irregularity and hence usually have microprolactinomas. Men and postmenopausal women often present later with macroadenomas, which may be invasive or giant tumors.
Treatment with dopamine agonists usually results in prolactin normalization, symptom improvement, and tumor shrinkage.
Prolactinomas are benign lactotroph adenomas expressing and secreting prolactin.
History and exam
Key diagnostic factors
- amenorrhea or oligomenorrhea
- 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])
- estrogen 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
- computerized visual-field examination
- Nonfunctioning pituitary macroadenomas
- Drug-induced hyperprolactinemia
- Primary hypothyroidism
- ACR appropriateness criteria: neuroendocrine imaging
- Clinical practice guidelines for the management of aggressive pituitary tumours and carcinomas
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