Prolactinoma

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Presentation :

• Galactorrhea, amenorrhea

Pathophysiology :

Diagnostic Testing:

• Evaluate for medication-induced hyperprolactinemia: Psychotropic agents, tricyclic antidepressants, antiseizure medications, metoclopramide and domperidone, calcium channel blockers, methyldopa, opioids, and protease inhibitors
  • The prolactin level influenced by drugs and other nonprolactinoma conditions is usually <150 ng/mL.
• Obtain a pregnancy test in all women with hyperprolactinemia.
• Obtain a serum TSH level in all patients with hyperprolactinemia (hypothyroidism can cause hyperprolactinemia).

Treatment :

• Observation for women with microprolactinoma and normal menses or for patients with nonfunctioning pituitary microadenomas.
• Dopamine agonist (cabergoline preferred to bromocriptine) for symptomatic prolactinoma
• Surgery for adenomas secreting GH, ACTH, or TSH; for adenomas associated with mass effect, visual field defects, or hypopituitarism; and for prolactinomas unresponsive to dopamine agonists.

Prognosis:

References: