From the Guidelines
Prolactinoma symptoms typically include delayed puberty, galactorrhoea, visual field loss, growth or pubertal arrest, and menstrual disturbance in girls, as well as gynaecomastia in boys, according to the most recent consensus guideline 1. These symptoms are a result of high serum levels of prolactin inhibiting gonadotrophin secretion, leading to hormonal imbalances and potential mass effects on surrounding brain structures. Key symptoms to look out for include:
- Delayed puberty, defined as more than 2 standard deviations later than the mean population age for sex
- Galactorrhoea, or inappropriate milk production
- Visual field loss, which can occur more commonly in boys than girls
- Growth or pubertal arrest, potentially leading to short stature
- Menstrual disturbance, including primary or secondary amenorrhea in post-menarcheal girls
- Gynaecomastia in boys, resulting from hypogonadism It is essential to measure serum prolactin levels in children and adolescents presenting with one or more of these symptoms, as early diagnosis and timely treatment can significantly improve outcomes 1.
From the Research
Prolactinoma Symptoms
- Hyperprolactinemia is commonly found in both female and male patients with abnormal sexual and/or reproductive function or with galactorrhea 2
- If serum prolactin levels are above 200 microg/L, a prolactin-secreting pituitary adenoma (prolactinoma) is the underlying cause 2
- Symptoms of prolactinoma include:
- Galactorrhea
- Amenorrhea or oligomenorrhea in women
- Erectile dysfunction or infertility in men
- Visual field defects
- Headaches
- Cranial nerve deficits
- Men generally have macroadenomas whereas women generally have microadenomas 3
Treatment and Management
- Primary therapy of prolactinomas is based on use of dopamine-receptor agonists such as cabergoline and bromocriptine 3, 4
- Cabergoline is very effective and well tolerated in more than 90% of patients with either microprolactinomas or macroprolactinomas 3
- Bromocriptine induces normalization of prolactin levels in 80-90% of patients with microprolactinomas and approximately 70% of those with macroprolactinomas 3
- Tumor-mass shrinkage and improvement of visual-field defects are found in the majority of treated macroprolactinomas 2, 3
- Surgical resection of the prolactinoma is the option for patients who may refuse or do not respond to long-term pharmacological therapy 2
- Radiotherapy and/or estrogens are also reasonable choices if surgery fails 2
Comparison of Dopamine Agonists
- Cabergoline was more effective than bromocriptine in reducing persistent hyperprolactinemia, amenorrhea/oligomenorrhea, and galactorrhea 5, 4
- Cabergoline has a more favorable profile than bromocriptine in terms of plasma half-life, efficacy, and tolerability 2
- More side effects were recorded in patients who took bromocriptine compared to cabergoline 5