Prolactinoma is a benign tumor of the pituitary gland. The pituitary gland in the brain overproduces the hormone prolactin. The effect of this overproduction of prolactin hormone in the body is to reduce the effect of sex hormones, namely estrogen in women and testosterone in men. Although prolactinoma is not life-threatening, it can cause visual impairment, infertility and other problems. In addition to prolactinoma, many other types of tumors can develop in the pituitary gland. Some of them produce excessive amounts of hormones, but most do not. In the treatment of prolactinoma, doctors usually give medication to bring the prolactin level back to normal. However, it may sometimes be necessary to remove the tumor surgically.
What are the Symptoms?
Symptoms are usually due to excessive levels of the hormone prolactin in the blood. If the tumor is very large, symptoms may also occur due to compression of the surrounding tissue. An increase in the hormone prolactin can cause disorders in the reproductive system. In some cases, there may be no symptoms. If there are symptoms, they usually go like this;
In women
– Irregular menstruation or absence of menstruation
– Milk coming from the breasts outside of pregnancy and lactation
– Painful sexual intercourse due to vaginal dryness
For men
– Impotence
– Thinning of body hair
– Rarely, enlargement of the breasts
Both sexes
– Decreased production of other hormones in the pituitary gland due to tumor compression
– Decreased sexual interest
– Headache
– Visual impairment
– Infertility
– Decrease in bone density
Symptoms usually occur earlier in women, even when the tumor is smaller, and rarely cause headaches and vision problems. In men, on the other hand, when the tumor grows larger, symptoms develop, causing neurological disorders and vision problems.
Why Does It Happen?
The pituitary gland is a gland in the lower part of the brain, about the size of a small pea. Although small, it is a gland that affects almost our whole body. It produces hormones that help regulate important functions such as growth, reproduction and blood pressure. It is part of the hormonal system that regulates many events in our body. In addition to the pituitary gland, the thyroid gland, parathyroid glands, adrenal glands, pancreas and ovaries are also involved in this system.
The exact cause of prolactinoma, a type of tumor of the pituitary gland, is still unknown. Almost all of them are benign. In other words, it does not spread to other parts of the body. However, it can increase in size. This can compress and damage the normal functioning gland tissue and prevent its production. It can also compress the adjacent optic nerve and cause visual impairment.
Overproduction of the hormone prolactin can also develop for reasons other than pituitary tumors. We can list them as follows;
– Some medications used. Some tranquilizers, some anti-nausea and acid reflux medicines, some blood pressure medicines.
– Other pituitary tumors
– Hypothyroidism
– Pregnancy, lactation and excessive stimulation of the breast. During pregnancy, prolactin levels increase to prepare the breasts for milk production. It returns to normal after birth. But it increases again when the baby starts to suckle. Constant stimulation of the breast causes milk to come out of the breast, regardless of the period of pregnancy and breastfeeding. It also causes a slight increase in prolactin levels.
What are the Risk Factors?
Most people who develop prolactinoma are under the age of 40. It is very rare in childhood. It is more common in women than in men. The age of women who develop prolactinoma is younger than the age of men who develop prolactinoma. That is, it develops earlier in women and later in men.
When to see a doctor?
If you have some of the symptoms of prolactinoma, you should consult your doctor to determine the cause. You will be treated with medication and your prolactin levels will return to normal. Thus, your complaints will disappear.
How is the diagnosis made?
The prolactin level is checked with a blood test. Your doctor may also order other tests. Computed tomography (CT) or magnetic resonance imaging (MRI) can be used to look for pituitary tumors in brain tissue. A vision test can be used to check whether your vision has deteriorated. In children, the hand and wrist bones can be measured to check whether bone development is normal. Further tests may also be necessary in cooperation with an endocrinologist.
What Can It Lead To?
Untreated prolactinomas can grow and press on the optic nerve and cause vision loss. Generally, vision loss starts at the edges. However, it can also lead to complete blindness. As the prolactinoma grows, it can compress normal pituitary tissue and disrupt the production of other hormones. This can lead to hypothyroidism, adrenal insufficiency and growth hormone deficiency.
It can cause osteoporosis, or bone loss, especially in women. An excess of the hormone prolactin can reduce estrogen production, leading to a decrease in bone density. During a normal pregnancy, the pituitary gland enlarges and prolactin production increases. However, if you already have prolactinoma before conception, the pituitary gland may enlarge even more when you become pregnant, causing symptoms such as headaches, visual disturbances, nausea, vomiting, excessive thirst and urination, and extreme fatigue. So if you have prolactinomania and want to become pregnant, tell your doctor about it. Because you will need to be closely monitored.
How is the treatment done?
The aims of treatment are;
– Normalization of prolactin production
– Normalization of pituitary gland function
– Reduced size of the pituitary gland
– Complaints related to tumor compression such as headache and vision problems disappear.
Prolactinoma treatment consists of two parts. The first is medication. The other is surgery. With medication, prolactin production is reduced and symptoms are eliminated. It also reduces the size of the tumor. However, drug treatment usually takes a while. When the prolactin level returns to normal and the tumor shrinks, the medication is stopped. Your doctor will of course decide when this will happen.
If medication is not successful or not tolerated, surgical removal of the tumor is another option. It can also be performed to reduce pressure on the optic nerve if vision is impaired. The type of surgery depends on the size and location of the tumor, but is usually performed through the nasal cavity. In this way, other parts of the brain are not touched, so there are no problems and there is no scarring. However, sometimes, especially for large tumors, it may be necessary to cut the skull. For very large tumors, some of which can be removed with surgery, medication is also given after the operation. Five years after the operation, there is a risk of the tumor recurring.