Updated: 12/26/2021

Prolactinoma

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  • Snapshot
    • A 42-year-old man presents to the clinic with complaint of decreased libido for the past month. He finds that he has a new problem of difficulty obtaining and maintaining an erection during sexual activity with his partner. He does not recall any instance of trauma to the area. On physical examination, he is found to have significantly impaired peripheral vision bilaterally and the chest findings seen in the image.
  • Introduction
    • Overview
      • a prolactinoma is a non-cancerous pituitary tumor that overproduces the hormone prolactin
        • treatment is usually with medication to restore a normal prolactin level or surgical resection
  • Epidemiology
    • Incidence
      • most common pituitary adenoma (40% of all pituitary adenomas)
    • Demographics
      • more common in women than men
      • peak prevalence in women ages 25-34 years
    • Location
      • pituitary gland
        • lateral parts of anterior pituitary are most common sites
  • ETIOLOGY
    • Pathophysiology
      • prolactinomas arise from monoclonal expansion of pituitary lactotrophs
        • results in excess synthesis and secretion of prolactin
          • ↑ prolactin inhibits GnRH secretion, leading to ↓ LH and FSH secretion
        • can cause hypopituitarism from mass effect
  • Presentation
    • Symptoms
      • headache
      • visual changes
        • visual field deficits
        • blurred vision
        • ↓ visual acuity
      • signs of hyperprolactinemia in women
        • amenorrhea or oligomenorrhea
        • infertility
        • loss of libido
        • galactorrhea
      • signs of hyperprolactinemia in men
        • loss of libido
        • impotence
        • erectile dysfunction
    • Physical exam
      • bilateral hemianopsia
        • mass lesion disrupts visual pathways crossing in the optic chiasm
      • galactorrhea
      • gynecomastia
  • Imaging
    • MRI or CT scan of the pituitary hypothalamic area
      • indications
        • determine if a mass lesion is present
  • Studies
    • Serum prolactin levels
      • measure on 1 or more occassions
    • Serum pregnancy test
      • rule out pregnancy as the cause of secondary amenorrhea in reproductive-aged females
    • Serum TSH
      • rule out the possibility of ↑ prolactin level secondary to an elevated TRH level
    • Serum testosterone levels
      • measure in men presenting with symptoms of hypogonadism
  • Treatment
    • Medical
      • bromocriptine or cabergoline (dopamine agonists)
        • indications
          • first-line treatment
            • dopamine suppresses prolactin secretion
    • Surgical
      • surgical resection
        • indications
          • patients who cannot tolerate or do not wish to take dopamine agonists
          • patients who do not respond to medical treatment or show progression after an initial response to medical treatment
  • Complications
    • Cranial nerve palsies due to mass effect
    • Infertility

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(M3.ON.16.33) a 34-year-old G2P2 woman presents to her obstetrician because of new onset discharge from her breast. She first noticed it in her bra a few days ago, but now she notes that at times she's soaking through to her blouse, which is mortifying. She was also concerned about being pregnant because she has not gotten her period in 3 months. In the office ß-HCG is negative. The patient's nipple discharge is guaiac negative. Which of the following therapies is most appropriate?

QID: 102974
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Tamoxifine

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Leuprolide

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Haloperidol

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Cabergoline

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Carbidopa-levodopa

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