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Concept
Prolactinoma
Summary
A prolactinoma is a tumor (adenoma) of the pituitary gland that produces the hormone prolactin. It is the most common type of functioning pituitary tumor. Symptoms of prolactinoma are due to abnormally high levels of prolactin in the blood (hyperprolactinemia), or due to pressure of the tumor on surrounding tissues. Based on size, a prolactinoma can be classified as a microprolactinoma (10 mm diameter).
Hyperprolactinaemia
The symptoms due to a prolactinoma are broadly divided into those that are caused by increased prolactin levels or mass effect.
Those that are caused by increased prolactin levels are:
Amenorrhea (disappearance of ovulation periods)
Galactorrhea (Milk production; infrequent in men)
Loss of axillary and pubic hair
Hypogonadism (Reduced function of the gonads.)
Gynecomastia (an increase in male breast size)
Erectile dysfunction (in males)
Those that are caused by mass effect are:
Headaches
Vision Changes-visual field deficits, blurred vision, decreased visual acuity
Cranial nerve palsies-especially with invasive tumors or with pituitary apoplexy
Seizures, Hydrocephalus, Unilateral exophthalmos are rare presentations
Hypopituitarism
Pituitary apoplexy is a medical emergency because of spontaneous hemorrhage into the pituitary tumor and presents with severe headaches, vision changes, and acute panhypopituitarism.
The cause of pituitary tumors remains unknown. Though most pituitary tumors are sporadic, some genetic syndromes include increased risk for pituitary adenomas including Multiple endocrine neoplasia type 1 (caused by a mutation in the MEN1 gene) and Familial isolated pituitary adenoma (FIPA).
The majority of moderately raised prolactin levels (up to 5000 mIU/L) are not due to microprolactinomas but other causes. The effects of some prescription drugs are the most common. Other causes are other pituitary tumours and normal pregnancy and breastfeeding. This is discussed more under hyperprolactinaemia.
Official source
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Dopamine agonist
A dopamine agonist (DA) is a compound that activates dopamine receptors. There are two families of dopamine receptors, D2-like and D1-like, and they are all G protein-coupled receptors. D1- and D5-receptors belong to the D1-like family and the D2-like family includes D2, D3 and D4 receptors. Dopamine agonists are primarily used in the treatment of Parkinson's disease, and to a lesser extent, in hyperprolactinemia and restless legs syndrome. They are also used off-label in the treatment of clinical depression.
Cabergoline
Cabergoline, sold under the brand name Dostinex among others, is a dopaminergic medication used in the treatment of high prolactin levels, prolactinomas, Parkinson's disease, and for other indications. It is taken by mouth. Cabergoline is an ergot derivative and a potent dopamine D2 receptor agonist. Cabergoline was patented in 1980 and approved for medical use in 1993. It is on the World Health Organization's List of Essential Medicines.
Hyperprolactinaemia
Hyperprolactinaemia is the presence of abnormally high levels of prolactin in the blood. Normal levels average to about 13 ng/mL in women, and 5 ng/mL in men, with an upper normal limit of serum prolactin levels being 15-25 ng/mL for both. When the fasting levels of prolactin in blood exceed this upper limit, hyperprolactinemia is indicated. Prolactin (PRL) is a peptide hormone produced by lactotroph cells in the anterior pituitary gland. PRL is involved in lactation after pregnancy and plays a vital role in breast development.