Prolactinoma

A benign pituitary tumor in the pituitary gland at the base of the brain that excessively secretes prolactin (milk hormone), the most common type of pituitary tumor.

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Skull Base and Pituitary Surgery

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1Overview

Quick and clear information for patients

What is this Condition?

Prolactinoma is a benign tumor that develops in the pituitary gland, located at the base of the brain just behind the eyes, which regulates hormonal balance throughout the body. This tumor excessively secretes prolactin (milk hormone), normally responsible for milk production in nursing mothers. It is the most common pituitary tumor and occurs much more frequently in women than in men. Elevated blood prolactin levels cause menstrual irregularities and difficulty conceiving in women, and decreased libido and erectile dysfunction in men. If the tumor grows, it may compress the optic nerve and affect vision. The good news is that this tumor can usually be successfully controlled with oral medications; surgery is rarely needed.

Symptoms

Menstrual irregularity or complete cessation of menses in women

Galactorrhea (milk discharge from breast when not pregnant or breastfeeding)

Infertility (difficulty conceiving)

Decreased libido; erectile dysfunction in men

Persistent headache

Blurred vision or visual field narrowing when tumor enlarges

Diagnosis Methods

There are two essential diagnostic steps: blood testing and imaging. Blood prolactin (milk hormone) levels are measured; significant elevation supports the diagnosis. It is verified that the elevation is not due to other causes such as pregnancy, certain medications, or thyroid disorders. Subsequently, contrast-enhanced pituitary MRI evaluates tumor presence, size, and whether it compresses the optic nerve. Visual field testing is performed if necessary.

Treatment Methods

The first-line treatment for prolactinoma is not surgery but oral medications. These medications, called dopamine agonists (for example, cabergoline), lower milk hormone levels, shrink the tumor, and largely correct symptoms; they are effective in the vast majority of patients. Treatment is continued for at least several years with regular blood tests and MRI follow-up. Surgery is generally considered only when there is no response to medication, medication cannot be tolerated, or in emergency situations such as sudden vision loss.

Oral dopamine agonist medications (e.g., cabergolone) to reduce prolactin hormone and shrink the tumor (first-line treatment)

Endoscopic transsphenoidal surgery when medication response is inadequate or intolerant

Pharmacological therapy (chemotherapy) for medication-resistant, mobile tumors at physician's discretion

Radiation therapy (radiotherapy) when other options are insufficient

Treatment Path

Related Treatments

The procedures and interventions most commonly explored with this condition.

4 links

Transsfenoidal hipofizektomi, endoskopik

Transsfenoidal hipofizektomi, endoskopik procedure

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Transsfenoidal hipofizektomi (adenomektomi)

Transsfenoidal hipofizektomi (adenomektomi) procedure

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CSF Fistula Surgery (Transsphenoidal Route)

CSF Fistula Surgery (Transsphenoidal Route) procedure

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Skull Base Dural Repair

Skull Base Dural Repair procedure

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References

Melmed S, ed. The Pituitary. 4th ed. London: Academic Press/Elsevier; 2017.
Honegger J, Reincke M, Petersenn S, eds. Pituitary Tumors: A Comprehensive and Interdisciplinary Approach. London: Academic Press/Elsevier; 2021.
Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023.
Melmed S, Casanueva FF, Hoffman AR, et al. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011:273-288.

This content is for informational purposes and based on academic sources; consult your physician for diagnosis and treatment.

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Prolactinoma

Skull Base and Pituitary Surgery

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

Related Treatments

Transsfenoidal hipofizektomi, endoskopik

Transsfenoidal hipofizektomi (adenomektomi)

CSF Fistula Surgery (Transsphenoidal Route)

Skull Base Dural Repair

References

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Transsfenoidal hipofizektomi, endoskopik

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CSF Fistula Surgery (Transsphenoidal Route)

Skull Base Dural Repair

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