What exactly are prolactinomas?
Breast milk formation is caused by a hormone called prolactin that originates from the lactotrophic cells in your pituitary gland.
Benign tumors arising in the pituitary gland when lactotrophic cells develop a mutation that ensures they divide repeatedly, producing a large number of cells and, in turn, prolactin over-production. This is called hyperprolactinemia.
At less than one centimeter in diameter, most prolactinomas remain very small; a minority grow to several centimeters. Approximately 10 percent contain both growth hormone and prolactin.
Interestingly the disease occurs in both men and women but it often occurs in women under the age of 50.
It is normal to find elevation of the pituitary hormone prolactin (hyperprolactinemia) in women with breast discharge, menstrual irregularities, and/or infertility. There are a variety of possible reasons for this uplift. Some medicines and low thyroid concentrations can increase prolactin levels. Small pituitary tumors usually often cause hyperprolactinemia, with no other abnormalities.
Prolactin is a stress hormone, and moderate prolactin elevations are seen through exercise, feeding, discomfort, and/or stimulation of the nipple.
If your prolactin level is high, making sure it is not a temporary abnormality is replicated in a fasting state. If the level is reasonably high and there is no apparent cause, such as medication or thyroid dysfunction, the doctor will prescribe a study of the pituitary gland.
Diagnosis and Symptoms
Women may have unexplained milk secretion, irregular and rare periods or infertility, and hot flushes or vaginal dryness may be present in more severe cases. This is because the raised prolactin levels inhibit estrogen production.
In fact, the condition accounts for 20 percent of infertility assessed women. Those affected by a cessation of time may also have a lower density of the spine and forearm bone than usual
Men will have impaired sexual function, as the increased level of prolactin inhibits the production of testosterone.
Less commonly, it can push against the optic nerve where a large tumor has formed, causing sight impairment and headaches.
The existence of a prolactinoma can be verified in all cases by the results of a blood test, which tests blood levels of prolactin. A pituitary MRI scan will then be done to indicate the presence of the benign tumor.
Treatment aims at decreasing prolactin levels and reducing tumor size. Typically this is accomplished by administering medications called dopamine agonists (most frequently named cabergoline), which is around 90 percent of patients have been shown to reduce prolactin levels to usual. This occurs within the first 2 to 3 weeks of therapy and then returns in premenopausal woman ovarian function, raise estrogen levels, return cycles, and regain fertility. Testosterone levels in men normally rise back to normal.
Cabergoline also decreases the size of the prolactinoma, while larger ones can take several weeks to months to demonstrate visible results.
Cabergoline’s side effects are relatively mild and include nausea, after-standing lightheadedness, and mental fogginess. This can be mitigated by beginning with a small dose and slowly can and taking the medication with food or at bedtime.
After initial treatment
The prolactin levels of the patient are routinely checked for pre-menopause and if these remain normal or suppressed-with no sign of a large tumor after three years-no the drug can be considered for a trial term.
Medication will have to resume if the levels increase again.
Postmenopausal women with small tumors typically do not have to proceed with medication, although women who have had larger prolactinomas and men who currently have larger prolactinomas are generally advised to continue taking medicine indefinitely to avoid any growth in size.