Prolactinoma, are the most commonly available pituitary tumors. They are involved in secretion of prolactin hormone and they are available in varying sizes. Prolactinoma stats that the tumors may arise from neoplasms that are found on the anterior pituitary lactotrophs and this leads to excessive production of the this hormone.
In normal women the prolactin hormone is secreted at the time of child birth as it facilitates the process of lactogenesis. Prolactinoma treatment and medication is based on the various symptoms associated with the prolactinoma. Although transpenoidal surgery is available and it can be applied to completely remove the tumor and ensures restoration of normal functions, most cases rely on medication for the treatment of this condition.
Almost eighty percent of people detected have been treated with the dopamine antagonist therapy and this has been found to be the most non invasive and effective method for treatment of pituitary tumors.
Most women suffering from disorders of the pituitary gland may go in for a prolactinoma in order to be able to conceive. Thus prolactinoma is considered to give hope to couple who are trying to conceive a baby. When a woman has a prolactinoma in the pituitary gland, it will lead to excessive production of it which inhibits fertility in women.
Therefore it would be advisable to get the prolactinaoma treated before trying to conceive a baby. There are many advantages as well as disadvantages deciding prolactinoma. It has been found that in most cases the patient suffering from prolactinoma will be evaluated for the size of the tumor as well as the location of the prolactinoma.
Other factor that must be considered before deciding on prolactinoma is the age and general health of the patient. Although removing a prolactinoma will restore normal activity in the pituitary gland and the woman may also be able to conceive normally, there are disadvantages as it has even found that is most of the cases the prolactinoma reappeared within a few years after prolactinoma.
Although there have been researches that are being consistently done to detect the causes of the occurrence, but the sources to actually detect their causes remain unknown.
Many of the instances are the ones where the pituitary adenoma appears sporadically in a person i.e. without any hereditary characteristics or any record being reported in the family of the person being affected by the pituitary adenoma.
There have been cases where some of the prolactinoma patients already have a genetic disorder which is called the multiple endocrine neoplasia type I (MEN I).
This is basically a condition of the pituitary adenoma where in the patient inherently gets the disorder because of the higher frequency of the occurrence of the peptic ulcer and the abnormal secretion of the hormones in the body which are produced from the pancreas, pituitary glands and the parathyroid.
Hence, the prolactinoma are the resultant feature of this MEN I disorder. But the people who have tendency to develop the prolactinoma need not necessarily have MEN I, as the specific genes in such cases are not yet fully detected.
Coming to the symptoms associated with prolactinoma, there are variations in the type of symptoms occurring in men and women.
In women, the high prolactin levels interrupt the ovulation, resulting in infertility, changes in menstrual cycles, production of breast milk in non breastfeeding mothers, loss of libido, and painful intercourses due to dryness in the vaginal region.
In men, the most common type is impotency followed by the visual problems, and loss of libido. But on an average, men tend to get larger prolactinoma of the pituitary adenoma than their female counterparts.
Diagnosis of the Prolactinoma and its Follow-up tests
The diagnosis of the prolactinoma is very important in order to detect its presence in the human body, and the elevations of this hormone called prolactin are normally detected by a simple blood test.
Though various indications of the level in men and women show the most common symptoms of infertility, galactorrhea (unexplained milk secretion in men and in non breastfeeding mothers), sexual dysfunctioning, etc, but if its secretion is much higher, then the functioning of the thyroid will be determined to gauge the effect of the pituitary adenoma.
Measuring and diagnosing the prolactinoma is effectively done through MRI (magnetic resonance imaging) and CT (computer tomography) scans, which provide a good picture of the pituitary adenoma.
Of the both, the magnetic resonance imaging is most sensitive to the test to check out the presence of the pituitary adenoma, as MRI scans may be repeated frequently to analyze the growth of the pituitary adenoma and the overall impact of the therapy.
Additionally, doctors also assess the tumor size on the MRI scan, to check out for the effect of the disease on the surrounding areas.
Follow-up tests post diagnosis:
Additional tests are often done after the main diagnosis of the pituitary adenoma for the assessment of the levels secreting from the pituitary gland.
This most commonly includes the eye test to examine the various visual fields, as the optic nerves are found in closer proximity to the pituitary gland and any extra growth of the pituitary gland can result in impingement on these optic nerves.
Prolactinoma surgery is known as transsphenoidal surgery, but there are very few patients who opt for the surgical treatment. The decision in favor of a prolactinoma surgery will depend on various factors like the size of the tumor, its location the age and health condition of the patient.
In case of mild symptoms where the patient can be treated with the help of medication, surgery is not preferred. Dopamine agonist therapy is applied for the treatment of prolactinomas. It was found that in eight percent of the cases, it was possible to suppress the effects of prolactinoma by administering medicines.
But in severe cases where the patient is not able to conceive due to prolactinoma the transspehnoidal surgery may be opted. In these cases the patient will not e responding well to medicines and then prolactinoma surgery will the only other alternative. It has been found that patients who had undergone a surgery developed another prolactinoma within two to three years after the treatment.
Prolactinoma and pregnancy
There are many cases where prolactinoma and pregnancy are possible and this goes against the common belief that prolactinoma causes infertility in women. According to the doctors, they say that there is no reason that explains why it and pregnancy cannot go hand in hand.
Most women who are having a pituitary gland disorder will be having a prolactin secreting tumor in the uterus. Most women who are affected by the prolactinoma can plan a pregnancy after they have been treated for prolactinoma. However at the onset of pregnancy the doctor may advice the patient to stop taking medication.
In case it causes various symptoms like excessive fatigue, nausea and changes in visual abilities it can lead to various complications and the doctor will also restart the medications of prolactinoma treatment.
In case this case, the doctor will closely monitor the development of the prolactin during the entire term of pregnancy and child birth. Women who have a small size prolactinoma are able to conceive are effective treatment of the prolactinoma pregnancy.
But, in case of prolactinoma pregnancy the women will be advised to stop the intake of treatment medication like bromocriptine as this may interfere with the normal growth of the fetus. If you are having this cancer and are pregnant now, it is advisable that your discuss your medical history with your doctor and get a regular checkup in order to ascertain the level of activity in the prolactinoma.
The doctor may conduct eye examinations in order to ascertain the growth of the prolactin secreting tumor in the pituitary gland of the pregnant women. It has been found that once a woman is able to deliver a normal baby after prolactinoma pregnancy then there is high probability that she will continue more successful pregnancies.
Prolactinoma in men
The most common symptoms that indicates the presence of prolactinoma in men is erectile dysfunction. According to statistics it has been revealed that in men it is identified in the latent stages.
Since prolactinoma in men does not cause any serious side effects, it is difficult to identify the presence of tumor in the pituitary gland until the tumor has enlarged and leads to other complications. When the tumor enlarges it may project into the sphenoidal bone or exert stress on the surrounding tissues.
At this stage the men will be suffering from severe headache and loss of eyesight. The prolactinoma in men can cause unexplained loss of eyesight and other complications. The doctor may conduct a radiology scan in order to identify the disease.
Although transphenoidal surgery is available or the treatment of the disease, medication has been found to be more safe and effective. It has been found that almost eighty percent of people suffering from prolactinoma resort to dopamine antagonist therapy from treatment of prolactinoma in men.
A huge MRI image shows the tumor extending into the sphenoid bone and cavernous sinuses. It has been found that most individuals having a pituitary prolactinoma lead a normal life, unless they show signs of progression of the tumor.
Some of the symptoms that lead to the diagnosis of prolactinoma in an individual include headache associated with abnormalities in eyesight. In case of women, there are irregular menstrual cycles which may also be absent at some times.
There is infertility in women, and they show signs of porlactinoma breasts. In this case, the women will be having very high level of prolactin that is being secreted by the prolactinoma in the pituitary gland.
Diagnosis is confirmed with a MRI radiological scanning. The MRI in males reveals elongated tumors that may be exerting pressure on the adjacent tissues thus causing abnormalities in vision.
Although in most cases the doctor may prescribe medication in order to treat the prolactinoma. But if the patient is not responding to bromospritine medication then the doctor will advice a prolactinoma MRI followed by a transspenoidal surgery.