Prolactinoma overview: Difference between revisions
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{{Prolactinoma}} | {{Prolactinoma}} | ||
{{CMG}} {{AE}}{{Faizan}} | {{CMG}}; {{AE}} {{Anmol}}, {{Faizan}} | ||
==Overview== | ==Overview== | ||
A | A prolactinoma is a [[benign]] [[tumor]] ([[adenoma]]) of the [[pituitary gland]] that produces [[prolactin]]. It is the most common type of [[pituitary tumor]]. Symptoms of prolactinoma are caused either by [[hyperprolactinemia]] or by pressure of the tumor on surrounding tissues. In women, these [[adenomas]] are often small (<10 mm). In either sex, however, they can become large enough to enlarge the [[sella turcica]]. These adenomas represent the most common [[hormone]]-producing [[pituitary tumors]] and account for 45% of all [[pituitary tumors]]. [[MRI]] is the most sensitive diagnostic test for detecting [[pituitary tumors]] (including [[prolactinoma]]). Medical therapy for prolactinoma includes [[dopamine]] agonists. Surgery is indicated in patients if medical therapy cannot be tolerated. Transsphenoidal resection of the tumor is rarely done among patients with [[prolactinoma]] as most of the patients respond to medical management. | ||
==Historical Perspective== | ==Historical Perspective== | ||
[[ | In 1970, [[prolactin]] was discovered in humans by sensitive [[bioassay]]. In 1978, V C Medvei, the President of the Section of History of Medicine (1986-87) of the Royal Society of Medicine in London, wrote in his paper that Queen Mary I of England was believed to have prolactinoma. | ||
==Classification== | ==Classification== | ||
[[Prolactinoma]] can be classified based either on size or local invasion. Based on size, a prolactinoma can be classified as a microprolactinoma (<10 mm diameter) or macroprolactinoma (>10 mm diameter). | |||
Prolactinoma may | ==Pathophysiology== | ||
[[Prolactinoma]] is the most common type of [[pituitary adenoma]]. [[Prolactinoma]] may occur in approximately 30% of [[multiple endocrine neoplasia type 1]] patients. It may also occur with [[Carney complex]] or [[McCune-Albright syndrome]]. There are a few reports of [[familial]] cases of [[prolactinoma]] unrelated to [[Multiple endocrine neoplasia type 1|MEN 1 syndrome]]. [[Prolactinoma]] is also associated with various [[familial]] syndromes. On gross pathology, [[prolactinoma]] is divided on the basis of size into microprolactinoma and macroprolactinoma. On [[histological]] analysis, [[prolactinoma]] may be divided into sparsely granulated and densely granulated prolactinomas. | |||
==Causes== | ==Causes== | ||
There are no established causes for [[prolactinoma]]. Most cases of [[prolactinoma]] are sporadic. [[Prolactinoma]] may occur in approximately 30% of [[multiple endocrine neoplasia type 1]] patients. It may also occur with [[Carney complex]] or [[McCune-Albright syndrome]]. | |||
== Differentiating prolactinoma from other diseases == | |||
[[Prolactinoma]] must be differentiated from other causes of [[hyperprolactinemia]] that may also present as [[galactorrhea]], [[amenorrhea]], (in females) and [[infertility]] (in both males and females). Causes of [[hyperprolactinemia]] can be categorized as [[physiological]], [[pathological]], and [[medication-induced]]. | |||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
[[ | 45% of [[Pituitary adenoma|pituitary adenomas]] are [[prolactinomas]], making it the most common type of all [[Pituitary adenoma|pituitary adenomas]]. Worldwide, the prevalence of sporadic [[prolactinoma]] is 6 to 10 per 100,000 persons. The prevalence of [[prolactinoma]] in people less than 20 years old is 10 per 100,000 individuals worldwide. [[Prolactinoma]] most commonly affects women in reproductive age group (20 to 50 years). [[Prolactinoma]] is more common in females than males in people between 20 and 50 years old. Frequency becomes similar after age 50. | ||
==Risk Factors== | ==Risk Factors== | ||
[[ | There are no established risk factors for [[prolactinoma]]. Some conditions increase the risk of [[prolactinoma]], such as [[multiple endocrine neoplasia type 1]] ([[MEN 1]]), [[Carney complex]], [[McCune-Albright Syndrome|McCune-Albright syndrome]], familial isolated [[pituitary adenoma]], and MEN 1 like [[syndrome]]. | ||
== | |||
== Screening == | |||
There is insufficient evidence to recommend routine [[Screening (medicine)|screening]] for [[prolactinoma]]. | |||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
[[ | If left untreated, 95% of cases of [[prolactinoma]] will not show any [[signs]] of [[growth]] during the first 4 to 6 years. Complications of [[prolactinoma]] include [[pituitary apoplexy]] and [[vision loss]]. [[Prognosis]] is generally excellent for cases of microprolactinoma. | ||
==History and Symptoms== | ==History and Symptoms== | ||
Common [[symptoms]] of [[prolactinoma]] include [[headache]], vision changes, decreased [[libido]], [[infertility]], and [[osteoporosis]]. In women, common [[symptoms]] of [[prolactinoma]] include [[breast]] tenderness, [[galactorrhea]], and [[amenorrhea]] or [[oligomenorrhea]]. | |||
==Physical Examination== | ==Physical Examination== | ||
Patients with [[prolactinoma]] generally appear healthy. The most common [[physical examination]] finding of [[prolactinoma]] is [[visual field]] defects ([[bitemporal hemianopsia]]). | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
Laboratory findings consistent with the diagnosis of [[prolactinoma]] include markedly elevated [[prolactin]] levels. | |||
==ECG== | |||
There are no [[ECG]] findings associated with [[prolactinoma]]. | |||
==X-ray== | |||
There are no [[X-ray]] findings associated with [[prolactinoma]]. | |||
==Ultrasound== | |||
There are no [[ultrasound]] findings associated with [[prolactinoma]]. | |||
==CT Scan== | ==CT Scan== | ||
[[ | [[CT scan]] of head is usually normal in patient of [[prolactinoma]]. Sometimes, enlargement of [[sella turcica]] may be found in case of macroprolactinoma. | ||
==MRI== | ==MRI== | ||
Magnetic resonance imaging ([[MRI]]) | [[MRI]] may be diagnostic of [[prolactinoma]]. [[Magnetic resonance imaging]] ([[MRI]]) is the most sensitive test for detection of [[pituitary tumors]] and determination of their size. | ||
==Medical Therapy== | ==Medical Therapy== | ||
Medical therapy for prolactinoma includes [[dopamine agonists]] (either [[cabergoline]] or [[bromocriptine]]). The goal of treatment is to return [[prolactin]] secretion to normal, reduce [[tumor]] size, correct any [[visual]] abnormalities, and restore normal [[pituitary]] function. | |||
==Surgery== | ==Surgery== | ||
[[Surgery]] | Surgery is not the first-line treatment option for patients with [[prolactinoma]]. [[Surgery]] is usually reserved for patients whose medical therapy fails to reduce the size of the [[tumor]]. | ||
==Primary prevention== | |||
There is no established method for [[primary prevention]] of [[prolactinoma]]. | |||
==Secondary prevention== | |||
There is no established method for [[secondary prevention]] of [[prolactinoma]]. | |||
== References == | == References == | ||
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Latest revision as of 23:50, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2], Faizan Sheraz, M.D. [3]
Overview
A prolactinoma is a benign tumor (adenoma) of the pituitary gland that produces prolactin. It is the most common type of pituitary tumor. Symptoms of prolactinoma are caused either by hyperprolactinemia or by pressure of the tumor on surrounding tissues. In women, these adenomas are often small (<10 mm). In either sex, however, they can become large enough to enlarge the sella turcica. These adenomas represent the most common hormone-producing pituitary tumors and account for 45% of all pituitary tumors. MRI is the most sensitive diagnostic test for detecting pituitary tumors (including prolactinoma). Medical therapy for prolactinoma includes dopamine agonists. Surgery is indicated in patients if medical therapy cannot be tolerated. Transsphenoidal resection of the tumor is rarely done among patients with prolactinoma as most of the patients respond to medical management.
Historical Perspective
In 1970, prolactin was discovered in humans by sensitive bioassay. In 1978, V C Medvei, the President of the Section of History of Medicine (1986-87) of the Royal Society of Medicine in London, wrote in his paper that Queen Mary I of England was believed to have prolactinoma.
Classification
Prolactinoma can be classified based either on size or local invasion. Based on size, a prolactinoma can be classified as a microprolactinoma (<10 mm diameter) or macroprolactinoma (>10 mm diameter).
Pathophysiology
Prolactinoma is the most common type of pituitary adenoma. Prolactinoma may occur in approximately 30% of multiple endocrine neoplasia type 1 patients. It may also occur with Carney complex or McCune-Albright syndrome. There are a few reports of familial cases of prolactinoma unrelated to MEN 1 syndrome. Prolactinoma is also associated with various familial syndromes. On gross pathology, prolactinoma is divided on the basis of size into microprolactinoma and macroprolactinoma. On histological analysis, prolactinoma may be divided into sparsely granulated and densely granulated prolactinomas.
Causes
There are no established causes for prolactinoma. Most cases of prolactinoma are sporadic. Prolactinoma may occur in approximately 30% of multiple endocrine neoplasia type 1 patients. It may also occur with Carney complex or McCune-Albright syndrome.
Differentiating prolactinoma from other diseases
Prolactinoma must be differentiated from other causes of hyperprolactinemia that may also present as galactorrhea, amenorrhea, (in females) and infertility (in both males and females). Causes of hyperprolactinemia can be categorized as physiological, pathological, and medication-induced.
Epidemiology and Demographics
45% of pituitary adenomas are prolactinomas, making it the most common type of all pituitary adenomas. Worldwide, the prevalence of sporadic prolactinoma is 6 to 10 per 100,000 persons. The prevalence of prolactinoma in people less than 20 years old is 10 per 100,000 individuals worldwide. Prolactinoma most commonly affects women in reproductive age group (20 to 50 years). Prolactinoma is more common in females than males in people between 20 and 50 years old. Frequency becomes similar after age 50.
Risk Factors
There are no established risk factors for prolactinoma. Some conditions increase the risk of prolactinoma, such as multiple endocrine neoplasia type 1 (MEN 1), Carney complex, McCune-Albright syndrome, familial isolated pituitary adenoma, and MEN 1 like syndrome.
Screening
There is insufficient evidence to recommend routine screening for prolactinoma.
Natural History, Complications and Prognosis
If left untreated, 95% of cases of prolactinoma will not show any signs of growth during the first 4 to 6 years. Complications of prolactinoma include pituitary apoplexy and vision loss. Prognosis is generally excellent for cases of microprolactinoma.
History and Symptoms
Common symptoms of prolactinoma include headache, vision changes, decreased libido, infertility, and osteoporosis. In women, common symptoms of prolactinoma include breast tenderness, galactorrhea, and amenorrhea or oligomenorrhea.
Physical Examination
Patients with prolactinoma generally appear healthy. The most common physical examination finding of prolactinoma is visual field defects (bitemporal hemianopsia).
Laboratory Findings
Laboratory findings consistent with the diagnosis of prolactinoma include markedly elevated prolactin levels.
ECG
There are no ECG findings associated with prolactinoma.
X-ray
There are no X-ray findings associated with prolactinoma.
Ultrasound
There are no ultrasound findings associated with prolactinoma.
CT Scan
CT scan of head is usually normal in patient of prolactinoma. Sometimes, enlargement of sella turcica may be found in case of macroprolactinoma.
MRI
MRI may be diagnostic of prolactinoma. Magnetic resonance imaging (MRI) is the most sensitive test for detection of pituitary tumors and determination of their size.
Medical Therapy
Medical therapy for prolactinoma includes dopamine agonists (either cabergoline or bromocriptine). The goal of treatment is to return prolactin secretion to normal, reduce tumor size, correct any visual abnormalities, and restore normal pituitary function.
Surgery
Surgery is not the first-line treatment option for patients with prolactinoma. Surgery is usually reserved for patients whose medical therapy fails to reduce the size of the tumor.
Primary prevention
There is no established method for primary prevention of prolactinoma.
Secondary prevention
There is no established method for secondary prevention of prolactinoma.
References