Prolactinoma

Prolactinoma is a pituitary tumor secreting PRL; the most common functional pituitary tumor. Typical manifestations: amenorrhea, galactorrhea, infertility, hyperprolactinemia, and possible sellar mass effect.

Common Symptoms

Galactorrhea-hyperprolactinemia; osteoporosis; increased bone density; amenorrhea-galactorrhea-infertility; hypopituitarism; nausea; amenorrhea

Causes

Causes of hyperprolactinemia: physiologic, pathologic, pharmacologic, or idiopathic. (1) Pathologic: hypothalamic-pituitary disease, most commonly prolactinoma. Other tumors/infiltrative/inflammatory disease/sarcoidosis/granuloma/trauma/radiation impair dopamine production or block portal flow, reducing PIF. Primary hypothyroidism, stress, neural stimulation increase PRF. Chronic renal failure reduces PRL clearance; cirrhosis impairs hepatic estrogen/PRL inactivation. SLE, Sjogren's, systemic sclerosis may also raise PRL. (2) Pharmacologic: dopamine receptor antagonists, estrogen oral contraceptives, antihypertensives, opioids, H2 blockers (cimetidine). Standard doses usually keep PRL <100 µg/L; oral domperidone 5-7 days gives 35-70 µg/L. Chlorpromazine 25 mg raises PRL 5-7x. (3) Prolactinoma: current view is intrinsic pituitary defect is the initiating cause; hypothalamic dysregulation is permissive/promotive. Candidate genes: HST, PTTG; tumor suppressor CDKN2A, MEN1. Monoclonal expansion leads to autonomous hormone secretion. Estrogen lowers PIF and weakens hypothalamic regulation; ~10% of prolactinomas arise postpartum; bromocriptine lowers PRL in ~90% and shrinks tumors. X-inactivation studies show most are monoclonal.

Treatment

Drug therapy; surgery; radiotherapy

Prevention

1. Treat symptomatic patients to correct hyperprolactinemia, suppress lactation, restore menses, prevent tumor growth and osteoporosis; follow up regularly. 2. Discontinue drugs that raise PRL.

Recommended Department

It is recommended to visit the endocrinology department; before the visit you may first book an appointment and connect with experts through this platform.

Warm reminder: The above information is provided for health education reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek care at a regular hospital in time.