Prolactin (PRL) adenoma is the most common functional pituitary adenoma, accounting for about 40-45% of functional pituitary adenomas in adults, with female patients aged 20-50 years old and a male to female ratio of about 1:10 in adults. standardized diagnosis and treatment of pituitary prolactin adenoma is of great significance in restoring and maintaining normal pituitary function and preventing tumor recurrence.
I. Clinical manifestations
The main clinical manifestations of pituitary prolactin adenoma are hypogonadism and its secondary symptoms, which may vary according to the age of onset, gender, duration and degree of prolactin increase.
1. Clinical manifestations of hyperprolactinemia
(1) Hypogonadism: Patients with prepubertal onset may show primary hypogonadism, i.e. primary amenorrhea in girls, no pubertal development in boys, and small testicular volume. Because male patients have insidious symptoms and low specificity, they are often overlooked resulting in late consultation.
(2) Lactation: Spontaneous or triggered lactation occurs in 30% -80% of female hyperprolactinemic patients, and the incidence of lactation is reduced after the development of hypogonadism due to low estrogen levels. Male patients may have mild mammary gland development, and a few patients may also experience lactation.
(3) Weight gain: The specific etiology is unclear and may be related to sodium and water retention, abnormal fat differentiation, hypogonadism and abnormal hypothalamic function.
2.Tumor local pressure symptoms
Mostly seen in pituitary prolactin macroadenoma. The most common local compression symptoms are headache and visual field defects (most commonly bilateral temporal hemianopia).
In addition, symptoms of multi-hormonal mixed adenoma or multiple endocrine adenomatosis and symptoms of pituitary stroke may appear.
II. Diagnosis
The diagnosis of prolactin adenoma can be made by combining typical clinical manifestations with laboratory tests of hyperprolactinemia (serum prolactin >100-200 μg/L) and MRI-enhanced imaging of the saddle area.
Western medicine drug treatment
1. Indications for drug treatment: For patients with prolactin microadenoma, the purpose of treatment is to control PRL level and preserve gonadal function and sexual function; for patients with large or huge prolactin adenoma, in addition to controlling PRL level and preserving pituitary function, it is necessary to control and reduce tumor volume, improve clinical symptoms and prevent recurrence.
Indications include: infertility, tumor-induced neurological symptoms (especially visual deficits), annoying lactation, chronic hypogonadism, altered pubertal development, and prevention of osteoporosis in women due to hypogonadism. Mild hyperprolactinemia, regular menstruation, women who want to get pregnant need to be treated.
2. Drug selection: Dopamine agonists (DA), the treatment of choice for patients with PRL adenoma, are now mainly bromocriptine (BRC) and carte blanche (CAB). Bromocriptine (2.5mg/tablet) Dosing: The initial dose of treatment is 0.625-1.25mg/d, which is recommended to be taken orally at night before bedtime with snacks. Increase 1.25mg at weekly intervals until reaching 2 tablets/d or 3 tablets/d.
IV. Surgical treatment
The choice of surgical treatment for pituitary prolactin adenoma should be based on the following conditions: tumor size, blood prolactin level, systemic condition, response to medication, patient’s wishes and requirements for fertility. Since microadenomas account for the majority of pituitary prolactin adenomas and most of them do not grow, surgical intervention is not usually the first choice.
V. Radiotherapy
Only as an option for patients with ineffective or intolerant medications, residual or recurrent post-surgery, or some aggressive or malignant prolactin adenomas.
Sixth, the treatment of Chinese medicine
1.Acupuncture treatment.
Acupuncture can significantly improve the patient’s headache, dizziness, blurred vision and other symptoms of high cranial pressure. The main acupuncture points are Baihui, Fengchi, blood supply, Sun, dizzy hearing area, Hegu, Foot Sanli, Fenglong and Taichong.
2. Chinese medicine treatment.
Mainly using the method of eliminating phlegm and dispersing knots, resolving blood stasis and clearing the ligaments: hemihsia, atractylodes, tianma, poria, orange red, whole scorpion, biliary south star, malt, angelica, red peony, chuanxiong, calamus, and epilobium.