From the Guidelines
A prolactinoma affects the body primarily by causing excessive production of the hormone prolactin, leading to various symptoms and health issues, and treatment typically involves dopamine agonist medications like cabergoline, which reduce tumor size and normalize prolactin levels in most patients 1.
Symptoms and Health Issues
The symptoms of a prolactinoma include:
- Menstrual irregularities, infertility, and inappropriate milk production (galactorrhea) in women
- Decreased libido, erectile dysfunction, and infertility in men
- Headaches, vision problems, and fatigue in both genders
- Additional symptoms caused by compression of nearby brain structures in large prolactinomas
Treatment
Treatment for prolactinoma typically involves:
- Dopamine agonist medications like cabergoline (0.25-1 mg twice weekly) or bromocriptine (2.5-15 mg daily)
- Long-term treatment, often for years, with regular blood tests to monitor prolactin levels
- Surgery reserved for patients who don't respond to medication or have severe visual impairment
- Cabergoline is the dopamine agonist of choice due to its superior effectiveness and lower adverse effect profile 1
Monitoring and Follow-up
Monitoring and follow-up for patients with prolactinoma include:
- Regular blood tests to monitor prolactin levels
- Imaging studies (e.g. MRI) to monitor tumor size and response to treatment
- Clinical assessment of symptoms and overall health
- Echocardiogram at the start of treatment with a dopamine agonist and yearly surveillance echocardiography for patients receiving >2 mg per week cabergoline 1
From the Research
Effects of Prolactinoma on the Body
- Hyperprolactinemia, a condition characterized by elevated serum prolactin levels, can cause abnormal sexual and/or reproductive function, galactorrhea, and other symptoms 2
- Prolactinomas, a type of pituitary tumor, can lead to pressure symptoms such as headaches, visual field defects, and cranial nerve deficits due to the tumor's size and location 2
- Elevated prolactin levels can disrupt normal gonadal function, leading to infertility, sexual dysfunction, and amenorrhea/oligomenorrhea in both men and women 3
Clinical Manifestations
- Galactorrhea, or spontaneous milk production, is a common symptom of hyperprolactinemia 2, 4
- Menstrual irregularities, such as amenorrhea or oligomenorrhea, are frequent in women with prolactinomas 2, 3
- Erectile dysfunction and decreased libido can occur in men with hyperprolactinemia 2
Treatment-Related Effects
- Dopamine agonists, such as cabergoline, can effectively reduce prolactin levels and shrink tumor size, but may cause side effects like nausea, vomiting, and headache 2, 3, 5, 4
- Surgical resection of the prolactinoma can be an option for patients who do not respond to medical therapy or have significant tumor growth 2, 3
- Radiotherapy may be considered for patients with resistant or aggressive tumors 2, 3, 6