eMedicine Specialties > Endocrinology > Pituitary Gland

Prolactinoma: Follow-up

Author: Venkatesh Babu Segu, MD, MBBS, DM, Associate Director of Diabetes Care Center, Department of Internal Medicine, St Mark's Hospital of Salt Lake City
Contributor Information and Disclosures

Updated: Sep 28, 2009

Follow-up

Further Outpatient Care

For patients receiving medical treatment, attempts should be made to continue maintenance treatment at the lowest effective dose to maintain PRL in the normal range. If a decision is made to withdraw medical treatment, especially in microprolactinoma patients, PRL levels and radiologic imaging with MRI or CT scanning should be periodically performed to monitor for recurrence and growth of prolactinoma. Medical treatment may be withdrawn cautiously after menopause in microprolactinoma patients, followed by biochemical and radiologic monitoring.23

Complications

  • Complications of untreated prolactinoma
    • Mass effects of the tumor may cause VF defects (and blindness), cranial nerve palsies, hydrocephalus, apoplexy (from hemorrhage/infarction into the tumor),24 and hypopituitarism (from compression of surrounding pituitary cells).
    • The effects of prolonged, untreated hyperprolactinemia can include hypergonadism, infertility, and osteoporosis.
  • Complications of the treatment of prolactinoma
    • No long-term complications have been reported with medical treatment.
    • Adverse effects of treatment are discussed in Medical Care and Medication. 
  • Complications of pituitary surgery
    • The mortality rate for transsphenoidal surgery is 0.27% for microadenomas and 0.86% for macroadenomas. The rate is higher in patients undergoing transcranial surgery and in patients who have been previously been treated with other modalities (~2.5%).
    • Morbidity includes cerebrospinal fluid rhinorrhea, diabetes insipidus (transient or permanent), meningitis, stroke, visual disturbances, and hypopituitarism (cumulative incidence rate of 2% for microadenomas and up to 14% for macroadenomas).
  • Complications of radiation treatment
    • The major complication is hypopituitarism. It occurs in 33-70% of patients; the incidence increases with the length of follow-up.
    • Less common complications include damage to the optic nerve/chiasm, seizures, vascular injury, and CNS malignancy.

Prognosis

  • Patients with microprolactinoma generally have an excellent prognosis. In up to 95% of patients, these tumors do not enlarge over a 4- to 6-year follow-up period. These patients generally do well for extended periods on suppressive therapy with DA agonists.
  • Macroprolactinomas have a tendency to grow with time and require aggressive treatment to prevent complications. The growth rate varies with the individual and cannot be reliably predicted. Careful monitoring of clinical signs and symptoms, coupled with pituitary imaging and with serial measurements of serum PRL levels (ie, to detect any major change in tumor behavior), remain the cornerstones of follow-up for these patients.25

Patient Education

  • The symptoms of prolactinoma should be explained to the patient, and patients should be advised to report any new or worsening symptom.
  • Female patients of reproductive age should be encouraged to practice barrier methods of contraception while on BEC (or similar agents), until menstrual cycles normalize. This facilitates accurate timing of any conception that may ensue and allows the physician to withhold BEC treatment upon conception.
  • For excellent patient education resources, visit eMedicine's Women's Health Center and Pregnancy and Reproduction Center. Also, see eMedicine's patient education articles Amenorrhea, Birth Control Overview, and Birth Control FAQs.
 


More on Prolactinoma

Overview: Prolactinoma
Differential Diagnoses & Workup: Prolactinoma
Treatment & Medication: Prolactinoma
Follow-up: Prolactinoma
References
Further Reading
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References

  1. Schlechte J, Dolan K, Sherman B, et al. The natural history of untreated hyperprolactinemia: a prospective analysis. J Clin Endocrinol Metab. Feb 1989;68(2):412-8. [Medline].

  2. Serri O. Progress in the management of hyperprolactinemia. N Engl J Med. Oct 6 1994;331(14):942-4. [Medline].

  3. Molitch ME. Prolactinoma. In: Melmed S, ed. The Pituitary. Boston, Mass: Blackwell Scientific; 1995:443-7.

  4. Zadrozna-Sliwka B, Bolanowski M, Jawiarczyk A, et al. The role of cyclase activating (CAP) and cyclase inhibiting (CIP) parathormone fractions in the assessment of bone metabolism disturbances in women with hyperprolactinemia of various origin. Neuro Endocrinol Lett. Feb 2008;29(1):178-84. [Medline].

  5. Mancini T, Casanueva FF, Giustina A. Hyperprolactinemia and prolactinomas. Endocrinol Metab Clin North Am. Mar 2008;37(1):67-99, viii. [Medline].

  6. Fernandez A, Karavitaki N, Wass JA. Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf). Jul 24 2009;[Medline].

  7. Carter JN, Tyson JE, Tolis G, et al. Prolactin-screening tumors and hypogonadism in 22 men. N Engl J Med. Oct 19 1978;299(16):847-52. [Medline].

  8. Schlechte JA. Clinical practice. Prolactinoma. N Engl J Med. Nov 20 2003;349(21):2035-41. [Medline].

  9. Hoffer ZS, Roth RL, Mathews M. Evidence for the partial dopamine-receptor agonist aripiprazole as a first-line treatment of psychosis in patients with iatrogenic or tumorogenic hyperprolactinemia. Psychosomatics. Jul-Aug 2009;50(4):317-24. [Medline].

  10. Honbo KS, van Herle AJ, Kellett KA. Serum prolactin levels in untreated primary hypothyroidism. Am J Med. May 1978;64(5):782-7. [Medline].

  11. Frantz AG. Endocrine diagnosis of prolactin-secreting pituitary tumors. In: Black PM, Zervas NT, Ridgway EC, et al, eds. Secretory Tumors of the Pituitary Gland. New York, NY: Raven Press; 1984:45-53.

  12. Frieze TW, Mong DP, Koops MK. "Hook effect" in prolactinomas: case report and review of literature. Endocr Pract. Jul-Aug 2002;8(4):296-303. [Medline].

  13. Rivera JL, Lal S, Ettigi P, et al. Effect of acute and chronic neuroleptic therapy on serum prolactin levels in men and women of different age groups. Clin Endocrinol (Oxf). May 1976;5(3):273-82. [Medline].

  14. Colao A, Di Sarno A, Sarnacchiaro F, et al. Prolactinomas resistant to standard dopamine agonists respond to chronic cabergoline treatment. Clin Endocrinol Metab. 1997;82(3):876-83. [Full Text].

  15. Webster J, Piscitelli G, Polli A, et al. A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline Comparative Study Group. N Engl J Med. Oct 6 1994;331(14):904-9. [Medline]. [Full Text].

  16. Molitch ME. Pharmacologic resistance in prolactinoma patients. Pituitary. 2005;8(1):43-52. [Medline].

  17. Swords F, Monson J, Besser GM, et al. Gamma knife radiosurgery: a safe and effective salvage treatment for pituitary tumors not controlled despite conventional radiotherapy. Eur J Endocrinol. Sep 22 2009;[Medline].

  18. Foyouzi N, Frisbaek Y, Norwitz ER. Pituitary gland and pregnancy. Obstet Gynecol Clin North Am. Dec 2004;31(4):873-92, xi. [Medline].

  19. Raymond JP, Goldstein E, Konopka P, et al. Follow-up of children born of bromocriptine-treated mothers. Horm Res. 1985;22(3):239-46. [Medline].

  20. Kreutzer J, Buslei R, Wallaschofski H, et al. Operative treatment of prolactinomas: indications and results in a current consecutive series of 212 patients. Eur J Endocrinol. Jan 2008;158(1):11-8. [Medline].

  21. Tyrrell JB, Lamborn KR, Hannegan LT, et al. Transsphenoidal microsurgical therapy of prolactinomas: initial outcomes and long-term results. Neurosurgery. Feb 1999;44(2):254-61; discussion 261-3. [Medline].

  22. Kars M, Pereira AM, Smit JW, et al. Long-term outcome of patients with macroprolactinomas initially treated with dopamine agonists. Eur J Intern Med. Jul 2009;20(4):387-93. [Medline].

  23. van der Klaauw AA, Kars M, Biermasz NR, et al. Disease specific impairments in quality of life during long-term follow-up of patients with different pituitary adenomas. Clin Endocrinol (Oxf). Apr 29 2008;[Medline].

  24. Zhang F, Chen J, Lu Y, et al. Manifestation, management and outcome of subclinical pituitary adenoma apoplexy. J Clin Neurosci. Oct 2009;16(10):1273-5. [Medline].

  25. Vaneckova M, Seidl Z, Hana V, et al. Macroprolactinomas: retrospective follow up study in the MR imaging and correlation with clinical symptomatology. Neuro Endocrinol Lett. Dec 2007;28(6):841-5. [Medline].

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Keywords

prolactinoma, prolactin, pituitary, pituitary gland, pituitary tumor, pituitary adenoma, pituitary tumors, bromocriptine, cabergoline, high prolactin levels, prolactin-secreting adenoma, hormone-secreting pituitary tumor, hyperprolactinemia, pituitary adenoma, growth hormone tumor, microprolactinoma, macroprolactinoma

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Contributor Information and Disclosures

Author

Venkatesh Babu Segu, MD, MBBS, DM, Associate Director of Diabetes Care Center, Department of Internal Medicine, St Mark's Hospital of Salt Lake City
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.

Medical Editor

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

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

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.

 
 
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