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.
D35.2 – Benign neoplasm of pituitary gland
134209002 – Prolactinoma
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.
Drug Reaction Data