Prolactinoma: What It Is, Causes, Symptoms & Treatment

Written by Medicover Team and Medically Reviewed by Dr Prashant Manohar Gaikwad , Endocrinologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Prolactinoma is a common type of benign (noncancerous) tumor that develops in the pituitary gland, a small gland located at the base of the brain that regulates various hormones in the body. This tumor causes excessive production of prolactin, the hormone primarily responsible for breast development and milk production.

Elevated prolactin levels can disrupt normal hormonal balance, leading to a variety of symptoms in both men and women, including reproductive, sexual, and metabolic issues.

Although prolactinomas are generally not life-threatening, early diagnosis and appropriate treatment are important to prevent complications and maintain overall health and quality of life.

What are the Symptoms of Prolactinoma?

The symptoms of prolactinoma can vary depending on the tumor size and the amount of prolactin produced.

In Women

Irregular or absent menstrual periods
Galactorrhea (milk discharge from the breasts)
Infertility
Decreased libido
Painful intercourse due to vaginal dryness

In Men

Erectile dysfunction
Decreased libido
Infertility
Gynecomastia (enlarged breasts)
Decreased muscle mass and body hair

General Symptoms

Headaches
Vision problems (due to the tumor pressing on the optic nerves)
Nausea and vomiting

What Causes Prolactinoma?

The exact cause of prolactinoma is not known. However, genetic factors and certain medical conditions may increase the risk of developing this tumor. For instance, multiple endocrine neoplasia type 1 (MEN1) is a hereditary condition that can cause tumors in the pituitary gland and other parts of the endocrine system.

When to See a Doctor for Prolactinoma?

If Prolactinoma causes persistent headaches, vision changes, menstrual irregularities, infertility, or symptoms that interfere with daily life, consult an Endocrinologist. As the tumor grows, it may affect nearby structures and hormone levels, sometimes requiring hospitalization or specialized treatment.

You should see a doctor if you have:

Irregular or absent menstrual periods, infertility, or unexpected breast milk production.
Decreased libido, erectile dysfunction, or other hormonal symptoms.
Persistent headaches or gradual changes in vision.

Get medical help immediately if:

Sudden severe headache with rapid vision loss or double vision.
Confusion, fainting, or symptoms suggesting pituitary apoplexy.
Severe nausea, vomiting, or sudden worsening of neurological symptoms.

These could be signs of a serious complication like Prolactinoma, which needs urgent care.

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How is Prolactinoma Diagnosed?

Diagnosing prolactinoma involves several steps. Your doctor will start with a detailed medical history and a physical examination. Additional tests are often required to confirm the diagnosis and assess the size and impact of the tumor.

Common diagnostic tests for prolactinoma include:

Blood Tests: Blood tests are essential for measuring prolactin levels. Elevated prolactin levels can indicate a prolactinoma.
Imaging Tests: Imaging tests, such as magnetic resonance imaging (MRI) or computed tomography (CT) scans, can help visualise the pituitary gland and detect a tumour.
Vision Tests: Since large prolactinomas can compress the optic nerves, vision tests may be performed to assess for vision problems.

What is the Treatment for Prolactinoma?

The treatment for prolactinoma depends on the tumor size, symptoms, and overall health of the patient. The main treatment options include medications, surgery, and radiation therapy.

Medications

Medications are often the first-line treatment for prolactinoma. Dopamine agonists, such as bromocriptine and cabergoline, are commonly prescribed to reduce prolactin production and shrink the tumor. These medications are effective for most patients and can help alleviate symptoms.

Surgery

Surgery may be considered if medications are not effective or if the tumor is causing significant symptoms, such as vision problems. The most common surgical procedure for prolactinoma is transsphenoidal surgery, where the tumor is removed through the nasal passages. This minimally invasive procedure has a shorter recovery time compared to traditional open surgery.

Surgery Recovery

Recovery from transsphenoidal surgery typically involves a few days in the hospital. Patients may experience nasal congestion, mild headaches, and fatigue. It is essential to follow the doctor's post-operative care instructions and attend follow-up appointments to monitor recovery and prolactin levels.

Radiation Therapy

Radiation therapy may be recommended for patients who do not respond to medications or surgery. This treatment uses high-energy rays to target and shrink the tumor. Radiation therapy is usually considered a last resort due to potential long-term side effects.

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How Can You Live with Prolactinoma?

Living with prolactinoma can be challenging, but with proper treatment and management, most patients can lead a normal life.

Regular follow-up appointments with your healthcare provider are crucial to monitor prolactin levels and adjust treatment as needed.

Additionally, maintaining a healthy lifestyle, managing stress, and adhering to prescribed medications can help manage symptoms and improve quality of life.

What Are the Risk Factors for Prolactinoma?

While the exact cause of prolactinoma remains unknown, several factors may increase the likelihood of developing this condition. Understanding these risk factors can help with early detection and management.

Genetic Disorders: Conditions such as Multiple Endocrine Neoplasia Type 1 (MEN1) increase the risk of pituitary tumors, including prolactinomas.
Family History: Individuals with a family history of endocrine gland disorders may have a higher risk.
Gender: Prolactinomas are more commonly diagnosed in women than in men, particularly during reproductive years.
Age: Most prolactinomas occur in adults aged 20 to 50 years.

What Are the Complications of Prolactinoma?

If left untreated, prolactinoma can lead to several complications due to prolonged elevation of prolactin levels and tumor growth.

Infertility: Elevated prolactin levels can interfere with normal reproductive function.
Vision Loss: Large tumors may compress the optic nerves and cause visual disturbances.
Bone Loss: Reduced estrogen or testosterone levels can lead to osteoporosis and an increased risk of fractures.
Pregnancy Complications: Women with untreated prolactinoma may face challenges during pregnancy.
Pituitary Dysfunction: Large tumors can affect the production of other important pituitary hormones.

How Can Prolactinoma Be Prevented?

There is no known way to completely prevent prolactinoma. However, early diagnosis and proper management can help reduce complications and improve long-term outcomes.

Regular Medical Check-ups: Routine health evaluations can help identify hormonal imbalances early.
Genetic Counseling: Individuals with a family history of MEN1 may benefit from genetic evaluation.
Follow Treatment Plans: Taking prescribed medications and attending follow-up appointments can help control tumor growth.
Monitor Symptoms: Seeking medical attention for menstrual irregularities, vision changes, or unexplained breast discharge can support early diagnosis.

Frequently Asked Questions

1. What are the symptoms of prolactinoma?

Symptoms may include irregular menstrual periods, galactorrhea (milk discharge), infertility, headaches, and vision problems in women, along with decreased libido, erectile dysfunction, and infertility in men.

2. What is the treatment for prolactinoma?

Treatment typically involves medications that lower prolactin levels and shrink the tumor. Surgery or radiation therapy may be considered when medications are ineffective or not tolerated.

3. What medications are used for prolactinoma?

Common medications include dopamine agonists such as Cabergoline and Bromocriptine, which effectively reduce prolactin production and tumor size.

4. What causes prolactinoma?

Prolactinoma is caused by a noncancerous tumor of the pituitary gland that produces excessive amounts of the hormone prolactin.

5. How is prolactinoma diagnosed?

Diagnosis involves blood tests to measure prolactin levels, hormone evaluations, and imaging studies such as MRI scans to examine the pituitary gland.

6. How serious is prolactinoma?

Prolactinomas are usually not life-threatening and often respond well to treatment. However, untreated tumors can cause hormonal problems, infertility, vision changes, and other complications.

7. Is a prolactinoma a brain tumour?

A prolactinoma is a pituitary tumor located at the base of the brain. It is considered a brain-region tumor but is typically benign and does not spread to other parts of the body.

8. What is the main reason for high prolactin?

The most common cause of significantly elevated prolactin levels is a prolactinoma. Other causes include pregnancy, certain medications, hypothyroidism, stress, and pituitary gland disorders.

9. Is prolactinoma preventable?

No. There is no known way to prevent prolactinoma because its exact cause is not fully understood. Early diagnosis and treatment can help prevent complications and improve outcomes.