Prolactinoma

4.6
(5)

Introduction:

  • Prolactinoma is the MC pituitary adenoma
  • Prolactinoma is the MC functional pituitary tumor
  • Types:
    1. Microadenoma: ≤10 mm
    2. Macroadenoma: >10 mm.

Mechanism of clinical features: Prolactin inhibits GnRH secretion

Typical clinical features:

  • MC presentation of prolactinoma: Infertility
  • Galactorrhea
  • Secondary amenorrhea.

Characteristic clinical feature:

  • Pituitary enlargement always occurs superiorly → pressing on optic chiasma → Bitemporal hemianopia (compression by macroadenoma is more common)

IOC: Serum prolactin level

Treatment:

  • Oral dopamine agonists (cabergoline and bromocriptine) are the mainstay of therapy for patients with micro- or macroprolactinomas
  • Dopamine agonists suppress PRL secretion and synthesis as well as lactotrope cell proliferation
  • In general, DOC of prolactinoma is Cabergoline as it is a long-acting dopamine agonist and effectively suppresses PRL for >14 days after a single oral dose and induces prolactinoma shrinkage in most patients
  • As Bromocriptine is a short-acting dopamine agonist, it is preferred DOC in pregnancy & young fertile females desiring a pregnancy
  • Important note: After 4 months of initial treatment with dopamine agonists, MRI is repeated.

What if a patient with prolactinoma on bromocriptine wants to conceive?

  • For women taking bromocriptine who desire pregnancy, mechanical contraception (barrier) should be used through 3 regular menstrual cycles to allow for conception timing
  • When pregnancy is confirmed, bromocriptine should be discontinued and PRL levels followed serially
  • For women harboring macroadenomas, regular visual field testing is recommended and the drug should be reinstituted if tumor growth is apparent
  • Surgical decompression (trans-sphenoidal resection) may be indicated if vision is threatened.

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