Prolactinoma overview: Difference between revisions
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{{Prolactinoma}} | {{Prolactinoma}} | ||
{{CMG}} {{AE}}{{Faizan}} | {{CMG}} {{AE}}{{Anmol}}, {{Faizan}} | ||
==Overview== | ==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 | 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.<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> [[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== | ==Historical Perspective== | ||
[[ | In 1970, [[Prolactin]] was discovered in human 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]] | [[Prolactinoma]] can be classified based upon either 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 [[Pituitary adenoma|Pituitary adenomas]]. | |||
[[Prolactinoma]] may occur | [[Prolactinoma]] may occur in approximately 30% of [[Multiple endocrine neoplasia type 1]].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: microprolactinoma and macroprolactinoma | |||
On microscopic histological analysis,[[prolactinoma]] has two types: sparsely granulated variant and densely granulated variant. | |||
==Causes== | ==Causes== | ||
There are no established causes for | 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]].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 [[prolactinoma]], making it the most common of all [[pituitary adenoma]].<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 age group <20 years is 10 per 100,000 individuals worldwide. | |||
[[Prolactinoma]] most commomly affects age group 20 to 50 years. | |||
[[Prolactinoma]] is more common in females than males in age group 20 to 50 years. Frequency becomes similar after age 50 years. | |||
==Risk Factors== | ==Risk Factors== | ||
There are no established risk factors for [[prolactinoma]]. | |||
Some conditions increases 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== | ==Differentiating prolactinoma from other diseases== | ||
[[Prolactinoma]] must be differentiated from other causes of hyperprolactinemia | [[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 | If left untreated, 95% of cases of [[prolactinoma]] will not show any signs of growth during the first 4 to 6 year period. Complications of [[prolactinoma]] include [[pituitary apoplexy]], 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. | |||
Most common physical examination finding of [[prolactinoma]] include [[visual field]] defects ([[bitemporal hemianopsia]]). | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
Laboratory findings consistent with the diagnosis of prolactinoma include elevated prolactin levels | Laboratory findings consistent with the diagnosis of [[prolactinoma]] include markedly elevated [[prolactin]] levels. | ||
==ECG== | |||
There is no ECG finding associated with [[prolactinoma]]. | |||
==X-ray== | |||
There is no X-ray finding associated with [[prolactinoma]]. | |||
==Ultrasound== | |||
There is no ultrasound finding associated with prolactinoma. | |||
==CT Scan== | ==CT Scan== | ||
On | On CT scan of head, [[prolactinoma]] is characterized by enlargement of the [[pituitary gland]]. | ||
==MRI== | ==MRI== | ||
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==Medical Therapy== | ==Medical Therapy== | ||
Medical therapy for prolactinoma includes [[dopamine agonists]]. The goal of treatment is to return [[prolactin]] secretion to normal, reduce [[tumor]] size, correct any [[visual]] abnormalities and restore normal [[pituitary]] function. | 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 in whom medical therapy fails to reduce the size of the [[tumor]]. | Surgery is not the first-line treatment option for patients with [[prolactinoma]]. | ||
[[Surgery]] is usually reserved for patients in whom 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 == | == References == | ||
Revision as of 20:56, 21 July 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 human by sensitive bioassay.[2]
Classification
Prolactinoma can be classified based upon either 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 adenomas.
Prolactinoma may occur in approximately 30% of Multiple endocrine neoplasia type 1.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: microprolactinoma and macroprolactinoma
On microscopic histological analysis,prolactinoma has two types: sparsely granulated variant and densely granulated variant.
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.It may also occur with Carney complex or McCune-Albright syndrome.[1]
Epidemiology and Demographics
45% of pituitary adenoma are prolactinoma, making it the most common of all pituitary adenoma.[1]
The prevalence of prolactinoma in age group <20 years is 10 per 100,000 individuals worldwide.
Prolactinoma most commomly affects age group 20 to 50 years.
Prolactinoma is more common in females than males in age group 20 to 50 years. Frequency becomes similar after age 50 years.
Risk Factors
There are no established risk factors for prolactinoma. Some conditions increases 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 year period. Complications of prolactinoma include pituitary apoplexy, 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.
Most common physical examination finding of prolactinoma include visual field defects (bitemporal hemianopsia).
Laboratory Findings
Laboratory findings consistent with the diagnosis of prolactinoma include markedly elevated prolactin levels.
ECG
There is no ECG finding associated with prolactinoma.
X-ray
There is no X-ray finding associated with prolactinoma.
Ultrasound
There is no ultrasound finding associated with prolactinoma.
CT Scan
On CT scan of head, prolactinoma is characterized by 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 in whom 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.