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Prolactinoma
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Prolactinoma

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Contributors: Abhijeet Waghray MD, Paritosh Prasad MD
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Synopsis

Prolactinomas are adenomas of the anterior lobe of the pituitary gland that produce prolactin. They are the most common type of pituitary gland adenomas, and they are associated with hyperprolactinemia. The majority of prolactinomas occur in women (>70%) with a minority of cases reported in children.

In premenopausal women, oligomenorrhea, amenorrhea, infertility, and, less often, spontaneous or expressive galactorrhea may be seen. Vaginal dryness and dyspareunia may also be features. Signs include decreased bone mineral density.

In postmenopausal women, presenting symptoms are related to the space-occupying effects of the tumor (headaches, visual disturbances such as bitemporal hemianopsia, etc) because they are already hypoestrogenic.

In men, symptoms may include impotence, infertility, decreased libido, and, rarely, gynecomastia.

Prolactinomas are nonmalignant lesions. They warrant treatment if they grow to a size resulting in neurologic symptoms or if resultant prolactinemia causes distressing symptoms or infertility.

Codes

ICD10CM:
D35.2 – Benign neoplasm of pituitary gland

SNOMEDCT:
134209002 – Prolactinoma

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Nonprolactinoma pituitary mass – Pituitary tumors can compress the pituitary stalk and obstruct hypothalamic inhibition on the prolactin-producing cells. This results in a moderately elevated serum prolactin concentration with a lesser degree of elevation than would be expected from a similar-sized prolactinoma. Testing of other pituitary hormone production may be helpful since only a pituitary adenoma results in hypersecretion of pituitary hormones.
  • Pregnancy or breastfeeding can result in physiologically normal elevated prolactin levels.
  • Macroprolactin can result in elevated prolactin levels without any clinical abnormality. The laboratory can precipitate macroprolactin prior to analysis for prolactin to avoid misdiagnosis.
  • Chronic renal failure can result in decreased clearance of prolactin and increased secretion of prolactin.
  • Chest wall injuries or nipple stimulation can transiently increase prolactin levels.
  • Medications, notably antipsychotics, can raise prolactin levels (see hyperprolactinemia).
  • Hypothyroidism can result in elevated prolactin levels.

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 03/29/2018
Last Updated: 04/20/2018
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Prolactinoma
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Prolactinoma (Premenopausal Female Symptoms) : Amenorrhea, Infertility, Visual impairment, Galactorrhea, Prolactin elevated
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