A Prolactinoma is the most common type of benign brain tumor. This type of tumor is commonly misdiagnosed. People normally may not present with a headache, but they have other systemic symptoms instead. Some patients present with sore lactating breasts that produce milk. Women may also experience changes in their menstrual cycles, such as shorter or delayed menses. Later, people will experience changes in their vision. Patients may present after automobile accidents or clumsiness when they were hit from the side because they had developed Bilateral Hemianopsia, where they lost their side vision.
Patients are diagnosed with a Prolactinoma by having high serum Prolactin levels. They are then confirmed with a MRI showing a growth of the Anterior Pituitary, which sits in the sella turcica of the brain. The sella turcica sits on top of the Optic Chiasm, which is being compressed causing the visual disturbances.
The Anterior Pituitary not only produces Prolactin, but it also produces five other hormones that may be diminished with the overproduction of Prolactin from the gland. These other hormones are Luteinizing Hormone (LH) and Follicular Stimulating Hormone (FSH), which produce progesterone and estrogen in women and testosterone, Mullerian Inhibiting Factor (MIF) and Androgen Binding Protein (ABP) in men. Adrenocorticotrophic Hormone (ACTH) is also produced, which causes the release of Cortisol from the adrenal gland. Thyroid Stimulating Hormone (TSH) comes from the Anterior Pituitary, which causes T3 and T4 thyroid hormones to be released from the thyroid gland. Growth Hormone(GH) is also produced which acts on all cells in the body for growth and repair and stimulates the release of Insulin-Like Growth Factor (IGF) from the liver to help maintain the body’s blood glucose levels. If the Prolactinoma is not treated, the Anterior Pituitary gland will not produce enough of these hormones to act on the other body organs to function properly, and patients will experience symptoms of decreased sexual functioning, Cushing’s Syndrome, Hypothyroidism, and Hyperglycemia.
There are a couple treatment options for a Prolactinoma. The first treatment option is medication. The best medical option is Bromocriptine. It is an older drug that has been used for many years, but it has several side effects, such as chest pain, confusion, and low blood sugar, that some patients cannot tolerate. So the alternative medication that can be prescribed instead is Carbergoline. These drugs are dopamine agonists that work to reduce the amount of Prolactin that is produced from the Anterior Pituitary in the brain. The ultimate treatment of a Prolactinoma is surgery. The procedure is surgical removal of the brain tumor out through the nose of the patient.
The prognosis of a Prolactinoma is very good. Ninety-five percent of the patients with this benign tumor have functional lives with few side effects. If the tumor is small, women will still be able to get pregnant and have children. Because Prolactin antagonizes estrogen release from the ovaries, women have an increased chance of getting Osteoporosis, so patients should be followed by their primary care physician and/or Neurologist to monitor the growth of the Prolactinoma. Luckily, Prolactinomas do not grow much after five years, and patients can determine their long-term treatments at that time.
So if you experience any changes of your menstrual cycle, vision, health, and/ or behavior, consult your doctor and ask “Do I Have A Prolactinoma?”