Prolactinoma Diagnosis and Treatment

Prolactinoma Diagnosis and Treatment

Prolactinoma is a mostly benign pituitary tumor that develops in the pituitary gland and causes excessive secretion of the prolactin hormone. The pituitary gland is a small structure located at the base of the brain, but it plays important roles in the hormonal system. When a prolactinoma develops, the prolactin level in the blood rises, and as a result, women may experience menstrual irregularities, milk discharge from the breasts, and infertility, while men may experience decreased sexual desire, low testosterone levels, and erectile problems.

The diagnosis and treatment process of prolactinoma is planned by taking into account the patient’s complaints, prolactin level, tumor size, and its effects on surrounding tissues. Prof. Dr. Ömür Günaldı states that hormonal examinations and radiological imaging should be evaluated together when assessing pituitary tumors.

How Is Prolactinoma Diagnosed?

Prolactinoma is not diagnosed with a single test alone. The patient’s complaints, hormone levels, medications being used, and pituitary MRI findings are evaluated together.

Prolactin Blood Test

One of the most important tests in the diagnostic process is measuring the prolactin level in the blood. A prolactin level that is higher than normal may require further investigation for prolactinoma.

However, elevated prolactin does not always mean that there is a pituitary tumor. Stress, pregnancy, breastfeeding, hypothyroidism, and certain medications may also increase prolactin levels. Therefore, the cause of elevated prolactin should be investigated in detail.

In some patients, the test may need to be repeated at a different time.

Pituitary MRI Imaging

When prolactinoma is suspected, magnetic resonance imaging, or MRI, is generally used to visualize the pituitary gland in detail.

MRI can be used to evaluate the tumor’s:

• Size,
• Location,
• Relationship with surrounding tissues,
• Proximity to the optic nerves,
• Position within the pituitary gland.

Prof. Dr. Ömür Günaldı emphasizes that especially in large pituitary tumors, the relationship between the tumor, the optic nerves, and other important anatomical structures in the surrounding area should be evaluated in detail.

What Are the Types of Prolactinoma?

Prolactinomas are generally classified according to their size.

Microprolactinoma

Prolactinomas smaller than 10 millimeters in diameter are called microprolactinomas. They may be detected at an earlier stage, especially in women.

Macroprolactinoma

Tumors that are 10 millimeters or larger in diameter are defined as macroprolactinomas. In large tumors, pressure-related symptoms such as headaches and narrowing of the visual field may occur.

In larger tumors, the production of other pituitary hormones may also be affected.

What Are the Symptoms of Prolactinoma?

The symptoms of prolactinoma may appear differently in women and men.

Common symptoms in women may include:

• Menstrual irregularities,
• Absence of menstruation,
• Milk discharge from the breasts,
• Difficulty becoming pregnant,
• Decreased sexual desire.

In men, symptoms may include:

• Decreased sexual desire,
• Low testosterone levels,
• Erectile problems,
• Infertility,
• Reduced muscle strength.

In large prolactinomas, both men and women may also develop headaches and vision problems.

How Is Prolactinoma Treated?

Prolactinoma treatment is planned individually according to the patient’s condition. In most patients, the first treatment option is medication.

Medication Treatment

The most commonly used medications in prolactinoma treatment are a group of drugs called dopamine agonists. These medications reduce prolactin secretion and may help shrink the tumor in many patients.

Cabergoline and bromocriptine are the main medications in this group.

With medication treatment:

• Prolactin levels may decrease,
• Menstrual cycles may return to normal,
• Sexual functions may improve,
• The tumor may shrink,
• Pressure on the visual pathways may decrease.

The type, dose, and duration of medication may vary from patient to patient. Hormone levels are regularly monitored during treatment.

When Is Prolactinoma Surgery Necessary?

Most patients with prolactinoma do not require surgery. However, surgical treatment may be considered in certain situations.

Surgery may be evaluated in the following cases:

• Inadequate response to medication treatment,
• Serious side effects caused by the medications,
• Pressure of the tumor on the optic nerves,
• Rapid tumor growth,
• Inability of the patient to tolerate medication treatment.

Prof. Dr. Ömür Günaldı states that when deciding on prolactinoma surgery, the tumor’s size and location, hormone levels, and the patient’s response to medication treatment should be evaluated together.

How Is Prolactinoma Surgery Performed?

A significant proportion of pituitary tumors can be removed using the endoscopic transsphenoidal surgical method performed through the nose.

With this method, the pituitary gland is reached through the nasal passage without making a large incision in the skull. The appropriate part of the tumor or the entire tumor is then removed when possible.

The success rate of surgery may vary depending on the size of the tumor, its spread to surrounding tissues, and the experience of the surgeon.

How Is Follow-Up Performed in Prolactinoma Treatment?

Regular follow-up is very important in prolactinoma treatment. In patients receiving medication, prolactin levels are measured at certain intervals.

When necessary, pituitary MRI imaging is performed to evaluate whether the tumor has shrunk.

Other pituitary hormones may also be monitored because large tumors can affect the normal functions of the pituitary gland.

Can Prolactinoma Be Completely Cured?

Prolactinoma is a condition that can be successfully controlled in many patients. Especially in small tumors, prolactin levels may return to normal and the tumor may shrink significantly with medication treatment.

In some patients, the medication may be reduced or discontinued under medical supervision after a certain treatment period. However, discontinuing treatment is not appropriate for every patient.

Because prolactin levels may rise again after treatment is stopped, regular follow-up should continue.

What Happens If Prolactinoma Is Not Treated?

Untreated prolactinoma may cause hormonal imbalances to continue and the tumor to grow.

Long-term elevation of prolactin may lead to menstrual irregularities and reduced bone density in women, while in men it may cause low testosterone levels and sexual dysfunction.

Large tumors may press on the optic nerves and cause visual field loss.

For this reason, it is important for people with headaches, vision problems, or significant hormonal symptoms to be evaluated.

Specialist Evaluation in Prolactinoma Diagnosis and Treatment

When prolactinoma is diagnosed, specialists in endocrinology, radiology, and, when necessary, neurosurgery may need to evaluate the patient together.

During the neurosurgical evaluation performed by Prof. Dr. Ömür Günaldı, the need for surgery is assessed by taking into account the tumor’s size, location, relationship with the optic nerves, and response to medication treatment.

The main goal of prolactinoma treatment is not only to reduce prolactin levels but also to restore hormonal balance, control tumor growth, and reduce pressure on surrounding structures. With regular medical follow-up and an appropriate treatment plan, successful outcomes can be achieved in many patients.

This content is for general informational purposes only and does not replace personal diagnosis or treatment advice.