Irregular menstruation, amenorrhea, lactation, and difficulty seeing …… may be due to a prolactinoma.
Adolescent or non-lactating women may unintentionally notice white fluid overflowing from their nipples without any other discomfort. This unexplained overflow may be due to a lactuloma.
These young women usually have regular menstrual periods, but gradually develop irregular cycles, decreased menstrual flow, progression to menopause, amenorrhea, and possibly weight gain. Gynecological treatment does not help. If there is also a headache or difficulty seeing clearly. This is when you should beware that you have a disease of the central nervous system called prolactinoma.
There are also a large number of women who have had normal sexual intercourse for a long time after marriage and without contraception, “only flowering, but no fruit”. After ruling out reproductive factors in both partners, prolactinoma may be an important reason for not having a baby.
Men who have experienced impotence, decreased sexual function, gradual headaches, or loss of vision should also consider prolactinoma when they are past the age of maturity.
What is a prolactinoma? Prolactinoma is an endocrine disorder caused by pituitary prolactinoma that secretes excessive amounts of prolactin (PRL).
What are the manifestations of prolactinoma? Amenorrhea, breast discharge, and infertility are the three main manifestations of the disease.
Menstrual disorders: primary amenorrhea accounts for 4% of cases. Secondary amenorrhea accounts for 89% and menorrhagia accounts for 7%. Function, luteal insufficiency accounted for 23. 77%.
Breast overflow: spontaneous overflow or extruded overflow. It can be bilateral or unilateral. The milk is white or yellow, watery, slurry, or lacteal. The breasts are mostly normal or with lobular hyperplasia or macromastia.
Infertility: Increased prolactin may inhibit ovulation causing infertility.
Complications Low estrogen response: seen in people with prolonged amenorrhea, such as flushing, palpitations, spontaneous sweating, vaginal dryness, painful intercourse, loss of libido, and osteoporosis.
Changes in vision and visual field: seen in pituitary tumors involving the optic nerve crossings, which can lead to loss of vision, headache, vertigo, hemianopia and blindness.
Hyperestrogenic response: moderate obesity, seborrhea, seizures, and hirsutism. Adolescent onset may also cause developmental delay. In men, prolactinoma is mainly characterized by impotence, breast development and infertility.
How is prolactinoma diagnosed?
Serum prolactin measurements combined with a CT scan or MRI of the pituitary gland can usually confirm the diagnosis. Prolactinoma is highly suspected when PRL > I100ug/L, and most often when PRL > I200ug/L. Hyperprolactinemia (including elevated serum PRL levels caused by certain medications such as stomach medications, antihypertensives, sleeping pills, etc. and stress) is most often considered when PRL < I100ug/L. Tests required for prolactinoma: 1) routine blood, urine, liver and kidney function; 2) X-ray; 3) CT; 4) intracranial magnetic resonance imaging (MRI) of the saddle area or CT if MRI is not possible; 5) measurement of serum PRL levels (blood drawn at 10:00 a.m. to 11:00 a.m. in a quiet state); 6) measurement of other anterior pituitary hormone levels (serum GH, FSH, LH TSH, ACTH, F; 24-hour urine uFc) Endocrine examination and prolactin function test (prolactin excitation and inhibition test). What treatments are available for prolactinoma? The treatment of prolactinoma is determined by the size of the tumor, the level of increased PRIPRL, symptoms and fertility requirements. Most patients with prolactinoma can resume menstruation and become pregnant after treatment. Drug therapy: Unlike other treatments for pituitary tumors, drug therapy for prolactinoma is currently the recommended and preferred treatment internationally. Among them, the first choice is bromocriptine which is currently the most commonly used drug in China. It is a semi-synthetic ergometrine derivative, a dopamine receptor agonist, which can inhibit PRI synthesis and release via receptor conversion. Bromocriptine therapy is indicated for all types of hyperprolactinemia (HPRI). It is also the therapy of choice for prolactinomas. Especially for young infertile patients who wish to have children, drug therapy should be the first choice. Surgical treatment: This is the traditional classical treatment. Since most of the prolactinomas cannot be completely removed, bromocriptine therapy is still required after surgery. The indications for surgical treatment of prolactinomas are: 1. pituitary PRL microadenomas with obvious borders, patients who are unwilling to take long-term medication or who cannot tolerate medication; 2. large tumors with acute pressure symptoms such as visual cross pressure. 3.Surgical treatment is generally required. Mainly applicable to: 1.Giant adenoma with no obvious effect of bromocriptine treatment for more than 3 months. 2.Patients who require fertility. However, surgical treatment is often incomplete, and bromocriptine treatment is still needed after surgery. Radiation therapy: Since most of the prolactinomas occur in women of childbearing age, the biggest side effect of radiation therapy is to cause hypopituitarism, which often requires lifelong replacement therapy with anterior pituitary hormones, so radiation therapy is often not the first choice of treatment. Radiation therapy is indicated as an adjunctive treatment for larger prolactinomas that can rapidly reduce intracranial pressure and improve symptoms after surgery. It can also prevent recurrence after drug discontinuation and achieve long-term control. Radiation therapy is preferred for patients who cannot be treated medically (including those who cannot tolerate medication and those with severe combined liver and kidney disease) and surgically.