Prolactinoma Clinical Presentation

  • Author: Venkatesh Babu Segu, MD, MBBS, DM; Chief Editor: George T Griffing, MD   more...
 
Updated: Apr 14, 2011
 

History

Prolactinomas can cause symptoms secondary to the hormonal effects of excess PRL and to the space-occupying effects of the tumor itself.

The clinical features of sustained hyperprolactinemia (which vary with the duration and degree of the condition, as well as with the age and sex of the patient) are as follows[2, 6] :

  • Reproductive-aged females can present with menstrual disturbance and/or infertility.[9] The usual menstrual aberration in these women is oligomenorrhea, amenorrhea, or the occurrence of irregular menstrual cycles. Occasionally, if the prolactinoma occurs in a person of younger age, delayed menarche can result.
  • Galactorrhea can be spontaneous or expressive (only upon squeezing of the nipples). Galactorrhea is observed in 30-80% of these women and can be quite distressing for the patient.
  • Other features of hypoestrogenism include vaginal dryness, dyspareunia, and a decline in bone mineral density (ie, osteopenia or osteoporosis).[5]
  • Men with prolactinoma have 1 or more features of hypogonadism, which may include decreased libido, erectile dysfunction, or infertility.[8] Gynecomastia is very unusual in these men. Galactorrhea is much less common in men than it is in women, and demonstrating galactorrhea in a male may require vigorous breast manipulation.
  • If a prolactinoma develops prepubertally, hyperprolactinemia may result in a female body habitus and small testicles.
  • If the prolactinoma is large enough to compress the surrounding normal hormone-secreting pituitary cells, it may result in deficiencies of 1 or more hormones (eg, thyroid-stimulating hormone [TSH], GH, adrenocorticotropic hormone).

Correlating with the size of the tumor, the space-occupying effects of prolactinoma are as follows:

  • Larger tumors are frequently associated with headache secondary to stretching of the pain-sensitive structures around the pituitary gland.
  • Encroachment of surrounding tissues may result in visual problems in the form of field defects. Visual problems range from bitemporal hemianopsia (from compression of the optic chiasm), which is common, to total vision loss and ophthalmoplegia (from compression of cranial nerves III, IV, or VI).
  • Postmenopausal women and elderly men frequently present only with the space-occupying effects of the tumor.
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Physical

  • In women, focus the physical examination on assessment for galactorrhea and the identification of clinical signs of estrogen deficiency.
  • In men, examine testicular size and consistency, as well as the pattern of hair on the body. Also assess for the rare occurrence of gynecomastia and/or galactorrhea.
  • In male and female patients, assess visual acuity and visual fields (by the confrontation method) and perform a cranial nerve examination at the bedside to help determine if the tumor has caused any mass effect.
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Contributor Information and Disclosures
Author

Venkatesh Babu Segu, MD, MBBS, DM  Endocrinologist, Medical Specialists Centers of Indiana, Munster

Venkatesh Babu Segu, MD, MBBS, DM is a member of the following medical societies: American Association of Clinical Endocrinologists, American Diabetes Association, and Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert A Gabbay, MD, PhD  Associate Professor of Medicine, Division of Endocrinology, Diabetes and Metabolism, Laurence M Demers Career Development Professor, Penn State College of Medicine; Director, Diabetes Program, Penn State Milton S Hershey Medical Center; Executive Director, Penn State Institute for Diabetes and Obesity

Robert A Gabbay, MD, PhD is a member of the following medical societies: American Association of Clinical Endocrinologists, American Diabetes Association, and Endocrine Society

Disclosure: Novo Nordisk Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Yoram Shenker, MD  Chief of Endocrinology Section, Veterans Affairs Medical Center of Madison; Interim Chief, Associate Professor, Department of Internal Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Wisconsin at Madison

Yoram Shenker, MD is a member of the following medical societies: American Heart Association, Central Society for Clinical Research, and Endocrine Society

Disclosure: Nothing to disclose.

Mark Cooper, MBBS, PhD, FRACP  Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

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