Prolactinoma

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What is Prolactinoma

Prolactinoma is a condition amongst women and some men where there is a benign which is mostly not cancerous tumor in the pituitary gland. The pituitary gland is also called as the master gland where it is responsible for secreting different kinds of hormones and one of which is prolactin. In women, prolactin is important especially those who just gave birth because the hormone helps in stimulating the breast to produce breast milk.

The Pituitary Gland

The pituitary gland is a very small gland located in the brain specifically near the sella turcica. It is called as the master gland because no matter how small it is, it produces or stimulates the production of different hormones in the body like:

  1. Prolactin which helps stimulates the production of breast milk after delivery.
  2. Growth hormone which regulates the growth of a person
  3. Adrenocorticotropin hormone which helps stimulates the adrenal glands in the production of cortisol. This is important in stress-related situations such as the fight or flight mechanism and the rest and repair mechanism of the body.
  4. Stimulates production of luteinizing hormone and the follicle-stimulating hormones. These are essential to help regulate the ovulation and balance the estrogen and progesterone levels to help in the menstrual cycle. The male counterparts also stimulate the testosterone level which is essential in sperm production.
  5. Produce TSH or the thyroid stimulating hormone. It helps regulate the thyroid gland which is important in the proper metabolism in the body.

Once the pituitary gland is damaged or when there is an abnormal growth, the production of hormones is compromised and in turn it will affect the body.

What you need to know about prolactinoma

Prolactinoma is a very common tumor in the pituitary gland. According to experts, about 30% of the pituitary adenomas are prolactinoma. The good thing about this illness is that it is non cancerous and this occurs to women who are mostly under 40 years old. There are 2 types of prolactinoma and these are classified according to the size.

The microadenoma is a type where its size is less than a centimeter. On the other hand, the macroadenmona has a size of more than 1 centimeter. Taking note of the size is important because this determines what type of therapy is done to the patient.

What causes prolactinoma?

Abnormal cell growth usually have unknown causes. Additionally, tumor in the pituitary glands are also considered sporadic which means that this is not due to heredity or genes. In many studies, the reason why this problem happen is because of the increased in prolactin levels which can reach up to 5000mIU/L

Signs and symptoms of prolactinoma

Prolactinoma does not only happen to women but in men as well. Males with this problem include signs and symptoms like impotence; gynecomastia or enlargement of the tissues in their breasts; headache and sometimes blurring of vision.

On the other hand, in women, the usual signs and symptoms of prolactinoma is galactorrhea. This is when breast milk comes out even though the person is not breastfeeding nor is pregnant. She can also feel breast tenderness, infertility, amenorrhea or stopping or missing menstruation for a month. They may also experience blurring vision and headache.

This is because the visual acuity is impaired by the increasing tumor in the brain. The optic nerve and the pituitary gland are close to each other so when the tumor increases the nerve is compressed. Decreased libido may also be experienced.

How prolactinoma is diagnosed

When a woman comes to the hospital for abnormal secretion of breast milk physicians will test for prolactin levels in the blood. Thorough medical history is asked as well as the signs and symptoms experienced.

Once there is an increase in the prolactin level, diagnostic imaging tests will also be required especially when there is about 90% chance that the problem is indeed a tumor in the pituitary gland. CT scan or computed tomography scan and MRI or magnetic resonance imaging is the top imaging diagnostic tools to be used. These will help assess the brain function and the progression of the tumor. The test is also used to know the exact measurement of the tumor’s size.

Treatment and prognosis

Since prolactinoma is non-cancerous in nature, there is a good chance of survival and going back to their normal activities and resume work. There is about 95% chance that the tumor will not grow back within 4 to 6 years or more.

The goal of the treatment is straightforward and conservative as much as possible. The treatment objectives are: reducing the size of the tumor; correct the visual problems and abnormalities brought about by the tumor; and to help restore the function of the master gland.

Treatment options

Medications

  • Dopamine. This helps in inhibiting the secretion of prolactin. This helps shrink the tumor and help in normalizing the prolactin levels in the blood. There are dopamine agonists’ drugs such as the cabergoline and the bromocorpine which helps reduce the size of the tumor to 80% less. These drugs are both FDA approved. Patient is also warned about the possible side effects of these drugs. For instance, in cabergoline, nausea and dizziness are likely to happen but these side effects are not as severe as taking Bromocorpine. When taking the Bromocorpine, it is important to consult the endocrinologist first because sudden withdrawal of the drug can lead the tumors to grow back and grow bigger.

Surgery

If the size is big and it compromised the other parts of the brain, surgery is then suggested. This process is very critical because it involves opening the brain and getting the tumor off the gland. Therefore, it is important to look for a skilled and experienced brain surgeon when opting for this treatment. Surgery is suggested when the level is below 250 mg/ml. Also after the surgery the patient will still need to go back to the medication therapy because the entire tumor is not removed from the brain. This process is too delicate that one wrong move can lead to further damage.

References

http://en.wikipedia.org/wiki/Prolactinoma

http://www.nlm.nih.gov/medlineplus/ency/article/000336.htm

http://www.medicinenet.com/prolactinoma/article.htm

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