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^{[14, 16]}:

Reproductive-aged females can present with menstrual disturbance and/or infertility.^[5]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).^[6]
Men with prolactinoma have 1 or more features of hypogonadism, which may include decreased libido, erectile dysfunction, or infertility.^[7]Gynecomastia is very unusual in these men.
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 same as any other large tumor:

Larger tumors are frequently associated with headache secondary to stretching of the pain-sensitive structures around the pituitary gland.^[8]
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 often present with the space-occupying effects of the tumor.

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.

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.

Differential Diagnoses

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