- Prolactinoma is the MC pituitary adenoma
- Prolactinoma is the MC functional pituitary tumor
- Microadenoma: ≤10 mm
- Macroadenoma: >10 mm.
Mechanism of clinical features: Prolactin inhibits GnRH secretion
Typical clinical features:
- MC presentation of prolactinoma: Infertility
- 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
- 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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