Prolactinoma

Changes in your hormones affect you both inside and out. Some changes are subtle. Others may be more obvious. If you're having headaches and visions problems, you may have a benign brain tumor. If these also come with fertility problems or fluid leaking from your chest, you may have a prolactinoma.

Prolactinomas are a kind of beinign tumor of the pituitary gland. They're also called pituitary adenomas. They aren't cancer, but they can affect your whole body.

These tumors make a hormone called prolactin (PRL). Prolactin causes a woman's body to produce milk during pregnancy and breastfeeding. Too much prolaction can also cause other symptoms, like infertility, in both men and women.

Excess prolactin from prolactinomas causes reduced reproductive function by inhibiting secretion of gonadotropin-releasing hormone (GnRH) by the hypothalamus. Normally GnRH stimulates the pituitary to produce luteinizing hormone (LH), which stimulates secretion of sex hormones. Inhibition of GnRH secretion by high levels of prolactin results in reproductive-related symptoms.

Prolactinoma Treatment at UVA Health

Prolactinomas are the most common type of hormone-secreting pituitary adenoma. Women are 5 times more likely than men to have them. Most prolactinomas appear in people under age 40 but are rare in children.

Early diagnosis allows for tumors to be diagnosed when they are small, which improves the chance of cure following surgery alone.

Prolactinomas can be treated effectively by medical therapy and rarely require surgical treatment.

The goals of treatment are to:

  • Restore production of PRL to normal
  • Stop and reverse the symptoms of prolactinomas
  • Correct other endocrine abnormalities (thyroid, adrenal, ovaries or testes)
  • Remove and/or destroy the tumor to restore endocrine function to normal and to relieve any symptoms directly related to the tumor

Medical Therapy

Dopamine agonist drugs mimic the effect of dopamine, which normally inhibits the secretion of prolactin. Medication is taken on an indefinite basis and is effective in some 90% of prolactinomas.

Medication commonly results in shrinkage of the prolactinoma, and after a few years of treatment, some small prolactinomas may disappear. You will still need regular follow-up visits. 

In women, medication usually results in restoration of menstrual cycles and ability to conceive. Larger tumors need continued treatment throughout pregnancy, but this is not required with smaller tumors.

Surgery

If medication fails, surgery may be an option. This can be achieved by a transsphenoidal operation through the nose, which avoids the brain and eye.

After Successful Surgery

Once your prolactinoma is completely removed, your symptoms should resolve within days.  

In larger tumors, usually in men, reproductive function may not return and additional treatment with replacement testosterone is required.

Radiation Therapy

Radiotherapy is most often performed after surgery has removed the majority of a tumor, but some tumor remains that can’t be safely removed.

We use two main approaches at UVA:

Symptoms of a Prolactinoma

Prolactinomas affect your reproductive hormones. Because of that, the symptoms are different for women and men.

Symptoms in women:

  • Periods are irregular or stop altogether
  • Breasts start to make milk (called galactorrhea, most common in women taking oral contraceptives)
  • Reduced sex drive
  • Infertility
  • Osteoporosis

Symptoms in men:

  • Reduced sex drive
  • Erectile dysfunction
  • Infertility
  • Enlargement of the breasts, called gynecomastia
  • Osteoporosis
  • Vision loss

Doctors can find a prolactinoma using either of these tests:

  • Serum prolactin value (Elevated prolactin of greater than 150 ng/ml generally indicates the presence of a tumor)
  • MRI scan