A noncancerous (benign) tumor that produces excessive Prolactin is called a prolactinoma. It usually causes infertility, irregular or lack menstrual periods, and milky nipple discharge. However, this benign tumor is often treatable with medicines or surgery.
This tumor grows in the pituitary gland, and it increases the production of Prolactin. While this is an essential hormone, when it becomes too much, you can experience some health problems. Furthermore, about 50% of all pituitary tumors are prolactinomas, which makes them the most common type of pituitary tumor.
In general, this hormone is responsible for the development of the mammary glands (within the breast tissue) and lactation. It also contributes to multiple processes in the body. If a person has an increased level of Prolactin in the body, it is called hyperprolactinemia.
While the thoughts of having a tumor so close to the brain can cause concerns, you should know that prolactinomas are not life-threatening.
Types of Prolactinomas
Healthcare professionals have divided this tumor into 2 types based on the tumor’s size. For example:
- Microprolactinomas – These types of prolactinomas are very small tumors (less than 1 centimeter or 3/8 of an inch in diameter). They account for at least 50% of all prolactinomas and usually impact women.
- Macroprolactinomas – These tumors are larger than the previous ones, and they tend to develop in men and at an older age.
Approximately 60% of men have macroprolactinomas, while 90%% of women have microprolactinomas among all people with these tumors.
Symptoms
The symptoms often appear differently among people with prolactinomas because they depend on some factors. For example, the size of the tumor, how much Prolactin it produces, and others. Check below some symptoms of prolactinoma in adults:
- Changes in menstrual periods that are not related to menopause, such as irregular periods or amenorrhea (lack of periods)
- Milky nipple discharge when a person is not pregnant or breastfeeding (galactorrhea)
- Vaginal dryness
- Painful sexual intercourse
- Male or female infertility
- Reduced sex drive (low libido)
- Erectile dysfunction (ED)
- Weight gain
- Gynecomastia (enlarged breast tissue in males)
If you develop large prolactinomas, you may also experience the following symptoms. Examples include:
- Headaches
- Nausea
- Vomiting
- Vision problems (such as reduced peripheral vision, double vision, and others)
- Sinus pressure or pain
- Dysosmia (problem with the sense of smell)
Usually, women notice the symptoms of prolactinomas earlier because of menstrual period changes and milky nipple discharge. However, if a female is administering hormonal medications (such as birth control pills or hormone replacement therapy), she may not experience these symptoms. Furthermore, postmenopausal women and men often have a delayed diagnosis.
However, prolactinomas can also affect children and cause delayed puberty. However, these benign tumors rarely impact children.
Causes
Healthcare professionals do not fully understand what exactly causes these abnormal growths. While most of them occur randomly, there are some genetic disorders that may increase your risk for prolactinoma. These include:
- MEN type 4
- FIPA (familial isolated pituitary adenomas)
- Multiple endocrine neoplasia (MEN) type 1
- In most cases, prolactinomas affect women between the ages of 20 and 50
- Other pituitary tumors
- Hormonal imbalances
- Some medicines (including antipsychotics, antihypertensives, and opioid pain relievers)
- Thyroid diseases
- Chest wall injuries
What Are The Long-term Effects of Prolactinoma?
People with prolactinomas can also experience the following complications, especially if they don’t get treatment. Check below some examples:
- Osteopenia
- Osteoporosis (bone loss)
- Infertility in both men and women
- Galactorrhea
- Sexual dysfunction
- Pituitary apoplexy (sudden bleeding into a tumor)
- Hypopituitarism
- Hydrocephalus
This document does not contain a complete list of prolactinoma complications. However, the previous complications can be prevented with early diagnosis and proper treatment.
How to Prevent Prolactinoma?
Generally, it is not possible to prevent these abnormal growths. The only thing you can do is genetic and imaging tests to catch prolactinomas in the early stages, especially if you have a family history of prolactinomas.
Diagnosis
Usually, the prolactinoma diagnosis begins with a physical examination and medical history evaluation. Doctors may also ask some questions about the symptoms to get more clues about the disease. If you experience milky nipple discharge, your doctor may also perform a breast examination. However, to confirm or rule out prolactinomas, physicians usually perform the following tests. Examples include:
- Prolactin blood test – This test is used to measure the Prolactin levels in the blood. If results show increased levels, it may indicate prolactinomas.
- Imaging tests – The following tests can confirm or rule out these benign tumors. Doctors usually perform a CT (computerized tomography) scan or an MRI (magnetic resonance imaging) scan.
- Testosterone level blood test – This test is used to measure Testosterone levels in men.
Once you are diagnosed with a prolactinoma, doctors may perform additional tests to determine the levels of other pituitary hormones. If you develop a large prolactinoma, physicians may also recommend an eye examination.
Treatment
These benign growths are highly treatable. Usually, doctors recommend medicines to treat them, but if you do not notice improvements, they can prescribe surgery or radiation therapy.
Medicines
Dopamine agonists are very effective in shrinking prolactinomas. Furthermore, these medications can regulate Prolactin levels. Physicians often prescribe Cabergoline and Bromocriptine. In most cases, the first medicine is Cabergoline because it works better and has fewer adverse reactions. The most common of them include nausea, vomiting, and dizziness. In general, you should take these medicines for at least two years to prevent a recurrent prolactinoma (especially if you develop a large one). After this period, doctors may gradually reduce the dose or even stop the medication.
Surgery
Commonly, doctors recommend surgery for people with prolactinomas in the following cases. Examples include:
- Dopamine agonists do not work
- Medications are not shrinking the tumor
- You administer antipsychotic medicines that interact with dopamine agonists
- Large prolactinomas
In most cases, doctors recommend one of the following surgeries. For example:
- Transsphenoidal surgery – It is one of the most common surgeries used to remove prolactinomas. During this procedure, surgeons will make a small incision at the back of the nasal cavity or under the upper lip to get access to the pituitary gland.
- Transcranial surgery – In such cases, surgeons will make an opening in the skull through which they will remove the prolactinoma. This type of surge is often prescribed by doctors if you have very large tumors.
Discuss with your doctor about the benefits and risks associated with surgery.
Radiation Therapy
This treatment is rarely used to treat prolactinomas. In most cases, it is recommended when medicines and surgery do not work, and Prolactin levels remain high.
Frequently Asked Questions
When should I see my healthcare provider?
In general, you should see a doctor if you notice any symptoms of prolactinoma or Prolactin levels do not decrease during treatment.
How serious is a prolactinoma?
In general, this benign tumor is not life-threatening, but it may cause serious health problems. These include vision problems, infertility, and others.
What are the symptoms of prolactinoma?
These include irregular or absent periods, milky discharge from the nipples, infertility, low libido, reduced body hair, and others. Do not hesitate to see a doctor if any of the previous symptoms occur. If you have any other questions, ask your healthcare provider.
