Prolactinoma

Diagnosis

Many tests can help diagnose a prolactinoma. If your symptoms suggest a prolactinoma, your healthcare professional may recommend:

• Blood tests to check if the pituitary gland is making too much prolactin and whether other hormone levels are normal. Pregnancy tests may also be advised if applicable.

• Brain imaging, usually an MRI, to detect a prolactinoma.

• Vision tests to see if the tumor is affecting sight.

Further evaluation by an endocrinologist may be needed for specialized care.

Treatment

Treatment for a prolactinoma depends on symptoms, tumor size, and overall health. Some small tumors that do not cause symptoms may not require treatment. For others, options include medicines, surgery, and rarely, radiation therapy. The goals of treatment are to:

• Lower prolactin levels to a healthy range.

• Shrink the tumor.

• Restore normal pituitary gland function.

Medicines
Dopamine agonists, such as cabergoline and bromocriptine, are commonly used. These medicines mimic dopamine, which controls prolactin production, helping lower hormone levels and shrink the tumor. Most people experience symptom relief, but the medicines are often taken long-term.

Common side effects include nausea, dizziness, nasal stuffiness, constipation, and headache. Starting with a low dose and taking the medicine with food or at bedtime can reduce side effects. Rarely, cabergoline may affect heart valves, and some people may develop impulse control disorders.

Pregnancy considerations
If planning pregnancy, discuss your treatment with your healthcare professional. Bromocriptine and cabergoline can be used before pregnancy. Most patients stop these medicines during pregnancy unless the tumor is large or symptoms like vision changes appear.

Surgery
Surgery may be needed if medicines are not effective, not tolerated, or to relieve pressure on surrounding tissue.

• Nasal surgery (transsphenoidal) removes the tumor through the nose and is common for most prolactinomas.

• Transcranial surgery (craniotomy) is used for large tumors or those affecting nearby tissue.

Surgery success depends on tumor size, location, prolactin levels, and the surgeon’s experience. Sometimes only part of a large tumor can be removed, and medicine may be needed afterward.

Radiation therapy
Rarely used for patients who do not respond to medicines, cannot undergo surgery, or have residual tumor after surgery. Radiation targets tumor cells to control growth.