Surgery is rarely needed and medication will usually suffice with an excellent prognosis
- Commonest secreting pituitary tumour
- Causing nearly 30% of pituitary tumours.
- Female/Male x 10 male
- Prolactinomas are found at post mortem and are often clinically silent
- Usually treatable medically
- Often none. silent until late. Often found at PM
- Galactorrhoea 90% of women and rare in men
- Amenorrhea,oligomenorrhea, reduced libido and infertility
- Long-term risk of low bone mineral density
- Hypogonadism as PRL suppresses testosterone level.
- Pituitary Tumour Mass Effects as described above may be seen
- Normal Serum prolactin < 20 ng/mL or 20 µg/L or 625 mU/L in women and 375 mU/L in men
- PRL high (Exclude macroprolactin) , testosterone low
- Pituitary MRI with Gadolinium shows microadenoma or macroadenoma
- Assess vision in those with suprasellar extension
- Assess biochemical pituitary function - see hypopituitarism
- Medical - The only pituitary tumour where medical treatment is usual.
- Dopamine agonists Bromocriptine or Cabergoline (Dostinex) which is given twice weekly to shrink tumour and surgery is rarely required. The best predictor of reoccurrence on stopping is the presence of residual tumor on MRI. The risk of cardiac valvulopathy appears to be low in prolactinoma patients on standard doses of cabergoline (< 2 mg/week).
- Transphenoidal hypophysectomy rarely if medical treatment fails or radiotherapy can be useful or there is a large tumour interfering with vision. Malignant prolactinomas are very rare.