Prolactinoma Follow-up

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

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 Medical treatment may be withdrawn cautiously after menopause in microprolactinoma patients, followed by biochemical and radiologic monitoring.[25]

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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),[26] 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.
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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.[27]
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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.
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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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