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Let’s talk about Prolactinoma

Drawing of the pituitary gland in the human brain

According to the @mayoclinic, prolactinoma is a noncancerous tumor of the pituitary gland. This tumor causes the pituitary to make too much of a hormone called prolactin. The major effect of prolactinoma is decreased levels of some sex hormones (estrogen in women and testosterone in men).

Symptoms

  • Prolactinoma might not cause any noticeable signs or symptoms. However, excessive prolactin in your blood (hyperprolactinemia) or pressure on surrounding tissues from a large tumor can cause signs or symptoms. 
  • Because elevated prolactin can disrupt the reproductive system (hypogonadism), some of the signs and symptoms of prolactinoma are specific to females or males.

In females, prolactinoma can cause:

  • Irregular menstrual periods or no menstrual periods
  • Milky discharge from the breasts when not pregnant or breast-feeding
  • Painful intercourse due to vaginal dryness
  • Acne and excessive body and facial hair growth

In males, prolactinoma can cause:

  • Erectile dysfunction
  • Decreased body and facial hair

What can cause prolactinoma? 

  • Prolactinoma is one type of tumor that develops in the pituitary gland. The cause of these tumors is unknown.
  • The pituitary gland is a small bean-shaped gland situated at the base of your brain. Despite its small size, the pituitary gland influences nearly every part of your body. Its hormones help regulate important functions such as growth, metabolism, blood pressure and reproduction.
  • Other possible causes of prolactin overproduction include medications, other types of pituitary tumors, an underactive thyroid gland, ongoing irritation to the chest, pregnancy and breast-feeding.

What effects can prolactinoma cause in some cases?

  • Bone loss (osteoporosis). Too much prolactin can reduce production of the hormones estrogen and testosterone, resulting in decreased bone density and an increased risk of osteoporosis.
  • Pregnancy complications. During a normal pregnancy, the production of estrogen increases. If you are pregnant and have a large prolactinoma, these high levels of estrogen may cause tumor growth and associated signs and symptoms, such as headaches and changes in vision.
  • Low levels of other pituitary hormones. With larger prolactinomas, pressure on the normal pituitary gland can lead to lower levels of other hormones controlled by the pituitary, including thyroid hormones and cortisol (a stress-response hormone).

When should I see a doctor?

If you develop signs and symptoms associated with prolactinoma, see your doctor or primary physician to determine the cause and discuss options. 

Can prolactinoma be treated?

In short, yes it can be treated through medications like bromocriptine (Parlodel) and cabergoline (Dostinex). These drugs act like the brain chemical dopamine, which normally keeps the pituitary gland from making too much prolactin.

  • According to @stanford.healthcare, the goal of treatment is to return prolactin secretion to normal, reduce tumor size, correct any visual abnormalities and restore normal pituitary function. In the case of very large tumors, only partial achievement of this goal may be possible. Because dopamine is the chemical that normally inhibits prolactin secretion, doctors first treat a prolactinoma with dopamine agents (agonists).
  • Bromocriptine shrinks the tumor and returns prolactin levels to normal in the majority of patients (80%)

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