Prolactinoma

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• QWhat do my high prolactin levels mean?

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  A Dr. Jack Merendino, MD , Endocrinology Diabetes & Metabolism, answered on behalf of The Best Life

  Prolactin is a hormone made by the pituitary gland. Its primary purpose is to promote milk production for a woman who is breastfeeding. In other situations an elevated prolactin level is abnormal and may cause problems.
  
  There are several symptoms or problems that can result from high prolactin levels. Breast enlargement or tenderness in men (called gynecomastia), or breast milk production in both men and women can occur. A high prolactin level sometimes causes infertility in a woman, or erectile dysfunction, a low testosterone level or a low sperm count in a man. If someone sees a doctor for any of these conditions, a prolactin level should be measured.
  
  A high prolactin level may result from a pituitary tumor which is releasing too much prolactin. Pituitary tumors are actually fairly common. They are rarely cancerous, but they can cause problems either by over-producing a hormone such as prolactin, or by growing in size and pressing on surrounding structures. If a person has symptoms that lead to a diagnosis of an elevated prolactin level, an MRI of the pituitary gland is usually performed unless there is another obvious cause, such as a medication for the elevated prolactin. At other times, a person has a CT scan or MRI scan of the brain for unrelated reasons and a pituitary tumor is identified when it was not suspected. In this case a prolactin level, as well as measurement of other pituitary hormones, is usually done, even if there seem to be no symptoms. When a person has a prolactin-secreting pituitary tumor the prolactin level is usually fairly high.
  
  Many times a person with a slightly elevated prolactin does not have a pituitary tumor on MRI scan. In this case, the tumor may be too small to be seen, or normal-appearing pituitary tissue may just be making too much prolactin. Some medications, especially those used to treat psychotic disorders such as schizophrenia, will cause the prolactin level to rise.
  
  If the prolactin level is just a little elevated, there is no tumor and there are no symptoms, treatment may not be necessary. If a drug causing a prolactin elevation can safely be stopped, the prolactin level will fall. If there is a large pituitary tumor, or a high level causing problems, a person can be treated with bromocriptine (Parlodel) or cabergoline (Dostinex) which will usually lower the prolactin level, shrink the tumor if there is one, and lead to improvement in symptoms.
• QCan prolactinoma be prevented?

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  A Dr. Jack Merendino, MD , Endocrinology Diabetes & Metabolism, answered

  Prolactin is a normal pituitary hormone. Its primary role is to promote breast milk production. A prolactinoma is a tumor in the pituitary gland that produces too much prolactin, often resulting in abnormal function of the ovaries or testes. A fall in testosterone levels or irregular periods and infertility for members of both sexes are common problems with a prolactinoma. Some medications that block dopamine action may increase the risk of prolactin-secreting tumors. Theoretically, avoiding these medications might reduce the risk of prolactinoma. However, the risk with these medicines is generally low and most of them are used to treat severe depression, psychosis or other major psychiatric problems so it would not be appropriate to avoid these medications simply to lessen the risk of a prolactinoma. Sometimes a person on such a medication has symptoms such as irregular menses or breast milk production that lead a doctor to check the prolactin level. If the level is high and there are symptoms, one will have to decide whether the prolactin elevation is enough of an issue to stop the medication, but this only happens in a small percentage of cases and is not a reason to avoid using the medications when they are really necessary. 

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• QHow do medications treat prolactinoma?

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  A Dr. Jack Merendino, MD , Endocrinology Diabetes & Metabolism, answered

  Medications such as bromocriptine (brand name Parlodel) and cabergoline (brand name Dostinex) work by mimicking the action of dopamine in the pituitary gland. Normally, nerve cells in the hypothalamus control prolactin release. The hypothalamus is a small part of the brain situated above the pituitary gland. Nerve cells in the hypothalamus release chemicals into blood vessels which connect the hypothalamus to the pituitary. These chemicals in turn control the release of various pituitary hormones, including growth hormone, ACTH, FSH, LH, TSH and prolactin. The main chemical regulating prolactin release is dopamine. Dopamine made by nerve cells in the hypothalamus prevents the release of prolactin.
   
  Many medications, especially those used for the treatment of schizophrenia and other serious psychiatric illness, work by blocking the effect of dopamine throughout the brain. This has favorable effects on mood and helps reduce hallucinations, but in the pituitary gland it increases prolactin levels since the inhibitory effect of dopamine on prolactin release is reduced. If there is damage to the hypothalamus or to the blood vessels connecting the hypothalamus to the pituitary, then prolactin levels rise because the inhibitory effect of the hypothalamus is lost. Such damage can occur as a result of head trauma or surgery or from an enlarging tumor of the pitutiary gland or structures close to the pituitary gland.
   
  Drugs that mimick the effect of dopamine reduce the production of prolactin and are therefore useful in a person with a prolactin-secreting pituitary tumor. The main drugs available for this purpose are those I listed at the outset: bromocriptine and cabergoline. The effect is lost within a matter of hours to days when the drugs are stopped, so they are generally used long-term.

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• QWhat are the treatment options for prolactinoma?

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  A Dr. Marvin Bergsneider, MD , Neurosurgery, answered on behalf of UCLA Health

  Dopamine is the chemical that shuts down prolactin release; however, there is a medication called cabergoline that acts just like dopamine. It acts on certain receptors that only respond in the pituitary gland, and it shuts down the production of prolactin in prolactinomas (prolactin-secreting tumors). When it does that, for many, many people, the pituitary tumor shrinks away. About a third of people can be cured just with this hormonal therapy. It's not chemotherapy; It's actually well tolerated. Most people don't require surgery if they have a prolactinoma. But about a third of people can't tolerate it, or it doesn't work well. Doctors still do surgery on people with prolactinomas. There are also other options, including radiation therapy, if medical therapy and surgical therapy don't work.

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• QWhat is prolactinoma?

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  A Dr. Joshua B. Bederson, MD , Neurosurgery, answered on behalf of The Mount Sinai Health System

  Prolactin-producing tumors (prolactinomas) account for about half of pituitary adenomas. They can cause a decrease in normal levels of sex hormones, estrogen in women and testosterone in men. Men may experience enlarged breasts and decrease of body hair, erectile dysfunction or impotence, infertility and loss of interest in sexual activity. Women may experience irregular or lack of menstrual periods, infertility and inappropriate breast milk production. Post-menopausal women suffer headaches and visual problems.

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• QWhat causes a prolactinoma?

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  A Sigma Nursing answered

  Prolactinoma is caused by a non-cancerous tumor that develops in the pituitary gland. The pituitary gland is a part of the brain that regulates many hormones, including the hormone called prolactin. Normally, this hormone stimulates the production of breast milk during and after pregnancy. When prolactinoma tumors develop, your body produces too much prolactin, which in turn lowers levels of other sex hormones. The cause of the tumor itself is unknown.

• QWhat are the symptoms of prolactinoma?

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  A Sigma Nursing answered

  The symptoms of prolactinoma may vary depending on the size of the tumor and the sex of the affected person. In some cases, especially when the tumor is still small, prolactinoma may not cause any noticeable symptoms. When symptoms occur in women, they often begin with irregular menstrual periods or a complete stop to menstrual periods. Women may also start producing breast milk, even if they're not pregnant or nursing. Men with prolactinoma may experience erectile dysfunction and, occasionally, decreased body hair. In both men and women, prolactinoma may cause low bone density, low sex drive, and infertility. If the tumor grows large enough to press on the optic nerve, it may cause headaches and problems with vision.

• QHow does prolactinoma affect the body?

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  A Sigma Nursing answered

  Prolactinoma begins with a tumor in the pituitary gland. The pituitary gland is a part of the brain that controls the production of many hormones, including prolactin (a hormone that controls the production of breast milk). When prolactinoma tumors develop, it causes too much prolactin, which may lead to a decrease in the levels of sex hormones (estrogen in women and testosterone in men) in the body. As a result, women may experience irregular menstrual periods or a total stop to menstrual periods. Women may also start producing breast milk, even if they're not pregnant or nursing. Both men and women may experience low bone density, low sex drive, and infertility. Depending on the size of the tumor, it may start pressing on the optic nerve and can cause headaches and problems with vision.

• QWhat increases my risk for prolactinoma?

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  A Sigma Nursing answered

  Even though the exact cause of prolactinoma is unknown, there are a few factors that may increase your risk for the condition. People between the ages of 20 and 50 are most commonly affected by prolactinoma, so your age may affect your risk. Prolactinoma and other pituitary tumors are also much more common among women, so your risk may be increased if you are a woman.

• QHow is a prolactinoma diagnosed?

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  A Sigma Nursing answered

  Diagnosing prolactinoma usually begins with a review of your symptoms and a physical exam. If doctors suspect you may have prolactinoma, they will perform a blood test to analyze the levels of prolactin and other hormones in your body. If doctors find that you have too much prolactin, they may perform imaging scans such as MRIs or CT scans, which can produce images of your brain and help a doctor see a tumor in your pituitary gland. If the tumor is large, doctors may also perform vision tests to see how much the tumor has affected your sight.