Cindy Criss: PROLACTINOMA

Pituitary Gland: "Master Gland." Important in regulating growth and development, metabolism, and reproduction.

Prolactinoma: The most common type of pituitary adenoma. Based on postmortem autopsies, 25% of U.S. population have a small pituitary tumor. A benign tumor of the pituitary gland causing an excessive amount of the hormone prolactin (natural hormone that aids in mild production) to be secreted. Symptoms develop when the tumor grows, putting pressure on the surrounding tissues. Hyperprolactinemia is the condition when prolactin increases in the bloodstream.

Function: Signals growth of breast tissue during pregnancy. Post pregnancy, the levels decrease unless the mother breastfeeds.

Symptoms Caused by Prolactinoma:
     Women: Ovulation interference, irregular menstrual cycles, and possible infertility. Non-pregnant, non-breastfeeding women may develop breastmilk. Decrease in sex drive may occur. Vaginal dryness may cause painful intercourse.
     Men: Impotence most common. Often do not go to doctor until headache and vision problems develop.

Diagnosis:
     Blood test: detect elevated prolactin levels.
     MRI: best test to detect and measure prolactinomas due to its sensitivity. Repeated periodically to monitor progression and effects of therapy.
     CT: sometimes used, but not as effective as MRI.

Post-Diagnosis Tests:
     Comprehensive eye exam.
Goals of Treatment:
     Return of normal prolactin secretion.
     Reduction in tumor size.
     Restore normal vision.
     Restore normal function on the pituitary gland.

Treatment:
     Medications first, surgery considered if medications not tolerated or effective.
     Medications may be used in conjunction with surgery and/or radiation therapy.
Medications: Dopamine mimicking medications that inhibit prolactin secretion.
     Parlodel
     Dostinex

Surgical Treatment: A very delicate surgery (performed by a neurosurgeon) involving an opening into the brain to access the tumor. This is often done by going through the roof of the mouth through the sphenoid sinus. Outcome highly depends on skill of surgeon, size of the tumor, and prolactin level.

Prognosis: With medications, sexual function and fertility will return.

References:

Ferry, R. Prolactinoma (pituitary tumor). (n.d) retrieved March 20, 2011, from MedicineNet.com Web Site: http://www.medicinenet.com/

Hurley, D. & K. Ho (2004). Pituitary disease in adults. retrieved March 20, 2011, from The Medical Journal of Australia Web Site: http://www.mja.com.au

Prolactin producing pituitary tumor. (n.d) retrieved March 20, 2011, from Health Resources Web Site: http://www.health-res.com/

Prolactinoma. (April, 2009). retrieved March 20, 2011, from lookforadiagnosis.com Web Site: http://www.lookforadiagnosis.com/

Prolactinoma. (2011). retrieved March 20, 2011, from University of Michigan Health System Web Site: http://www.med.umich.edu/