Prolactinoma overview: Difference between revisions
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==Historical Perspective== | ==Historical Perspective== | ||
In 1970, [[ | In 1970, [[prolactin]] was discovered in humans by sensitive [[bioassay]].<ref name="Frantz1978">{{cite journal|last1=Frantz|first1=Andrew G.|title=Prolactin|journal=New England Journal of Medicine|volume=298|issue=4|year=1978|pages=201–207|issn=0028-4793|doi=10.1056/NEJM197801262980408}}</ref> | ||
==Classification== | ==Classification== | ||
[[Prolactinoma]] can be classified based | [[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== | ==Pathophysiology== | ||
[[Prolactinoma]] is the most common type of [[ | [[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]].<ref name="pmid16411062">{{cite journal| author=Ciccarelli A, Daly AF, Beckers A| title=The epidemiology of prolactinomas. | journal=Pituitary | year= 2005 | volume= 8 | issue= 1 | pages= 3-6 | pmid=16411062 | doi=10.1007/s11102-005-5079-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16411062 }} </ref> [[Prolactinoma]] is also associated with various [[familial]] syndromes.<ref name="pmid17613551">{{cite journal| author=Karhu A, Aaltonen LA| title=Susceptibility to pituitary neoplasia related to MEN-1, CDKN1B and AIP mutations: an update. | journal=Hum Mol Genet | year= 2007 | volume= 16 Spec No 1 | issue= | pages= R73-9 | pmid=17613551 | doi=10.1093/hmg/ddm036 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17613551 }} </ref> On gross pathology, [[prolactinoma]] is divided on the basis of size into microprolactinoma and macroprolactinoma. On microscopic histological analysis, [[prolactinoma]] has two types: sparsely granulated and densely granulated. | ||
==Causes== | ==Causes== | ||
There are no established causes for [[prolactinoma]]. Most cases of [[prolactinoma]] are sporadic. [[Prolactinoma]] may occur in approximately 30% of [[ | 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]].<ref name="pmid16411062">{{cite journal| author=Ciccarelli A, Daly AF, Beckers A| title=The epidemiology of prolactinomas. | journal=Pituitary | year= 2005 | volume= 8 | issue= 1 | pages= 3-6 | pmid=16411062 | doi=10.1007/s11102-005-5079-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16411062 }} </ref> | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
45% of [[pituitary adenoma]] are [[ | 45% of [[pituitary adenoma|pituitary adenomas]] are [[prolactinomas]], making it the most common type of all [[pituitary adenoma|pituitary adenomas]].<ref name="pmid16411062">{{cite journal| author=Ciccarelli A, Daly AF, Beckers A| title=The epidemiology of prolactinomas. | journal=Pituitary | year= 2005 | volume= 8 | issue= 1 | pages= 3-6 | pmid=16411062 | doi=10.1007/s11102-005-5079-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16411062 }} </ref> The [[prevalence]] of [[prolactinoma]] in people less than 20 years old is 10 per 100,000 individuals worldwide. [[Prolactinoma]] most commonly affects people between 20 and 50 years old. [[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 | 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]]. | ||
==Differentiating prolactinoma from other diseases== | ==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]]. | [[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]]. | ||
==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 | 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]]. | 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]]. | In women, common symptoms of [[prolactinoma]] include breast tenderness, [[galactorrhea]], and [[amenorrhea]] or [[oligomenorrhea]]. | ||
==Physical Examination== | ==Physical Examination== | ||
Patients with [[prolactinoma]] generally appear healthy. | Patients with [[prolactinoma]] generally appear healthy. The most common [[physical examination]] finding of [[prolactinoma]] is [[visual field]] defects ([[bitemporal hemianopsia]]). | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
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==ECG== | ==ECG== | ||
There | There are no [[ECG]] findings associated with [[prolactinoma]]. | ||
==X-ray== | ==X-ray== | ||
There | There are no [[X-ray]] findings associated with [[prolactinoma]]. | ||
==Ultrasound== | ==Ultrasound== | ||
There | There are no [[ultrasound]] findings associated with [[prolactinoma]]. | ||
==CT Scan== | ==CT Scan== | ||
On [[CT scan]] of head, [[prolactinoma]] is characterized by enlargement of the [[pituitary gland]]. | On [[CT scan]] of the head, [[prolactinoma]] is characterized by an enlargement of the [[pituitary gland]]. | ||
==MRI== | ==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. | [[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 [[ | 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.<ref name="pmid21296991">{{cite journal| author=Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA et al.| title=Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. | journal=J Clin Endocrinol Metab | year= 2011 | volume= 96 | issue= 2 | pages= 273-88 | pmid=21296991 | doi=10.1210/jc.2010-1692 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21296991 }} </ref> | ||
==Surgery== | ==Surgery== | ||
Surgery is not the first-line treatment option for patients with [[prolactinoma]]. [[Surgery]] is usually reserved for patients | 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== | ==Primary prevention== | ||
Revision as of 18:14, 8 August 2017
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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.[1] 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 tumor is usually done among patients with prolactinoma.
Historical Perspective
In 1970, prolactin was discovered in humans by sensitive bioassay.[2]
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.[1] Prolactinoma is also associated with various familial syndromes.[3] On gross pathology, prolactinoma is divided on the basis of size into microprolactinoma and macroprolactinoma. On microscopic histological analysis, prolactinoma has two types: sparsely granulated and densely granulated.
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.[1]
Epidemiology and Demographics
45% of pituitary adenomas are prolactinomas, making it the most common type of all pituitary adenomas.[1] The prevalence of prolactinoma in people less than 20 years old is 10 per 100,000 individuals worldwide. Prolactinoma most commonly affects people between 20 and 50 years old. 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.
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.
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
On CT scan of the head, prolactinoma is characterized by an enlargement of the pituitary gland.
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.[4]
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 primary prevention of prolactinoma.
References
- ↑ 1.0 1.1 1.2 1.3 Ciccarelli A, Daly AF, Beckers A (2005). "The epidemiology of prolactinomas". Pituitary. 8 (1): 3–6. doi:10.1007/s11102-005-5079-0. PMID 16411062.
- ↑ Frantz, Andrew G. (1978). "Prolactin". New England Journal of Medicine. 298 (4): 201–207. doi:10.1056/NEJM197801262980408. ISSN 0028-4793.
- ↑ Karhu A, Aaltonen LA (2007). "Susceptibility to pituitary neoplasia related to MEN-1, CDKN1B and AIP mutations: an update". Hum Mol Genet. 16 Spec No 1: R73–9. doi:10.1093/hmg/ddm036. PMID 17613551.
- ↑ Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA; et al. (2011). "Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline". J Clin Endocrinol Metab. 96 (2): 273–88. doi:10.1210/jc.2010-1692. PMID 21296991.