Prolactinoma is a benign tumor that grows in the brain, specifically in the pituitary gland ( pituitary ). These tumors cause the hormone prolactin to be overproduced. This condition can cause fertility problems in both men and women.
Prolactinoma occurs when cells in the pituitary gland grow and develop excessively, forming a tumor. The growth of this tumor causes the production of sex hormones (testosterone in men and estrogen in women) to decrease.
Based on its size, prolactinoma is divided into three, namely microprolactinoma (less than 10 mm), macroprolactinoma (more than 10 mm), and giant prolactinoma ( more than 4 cm).
Causes of Prolactinoma
It's not known exactly what causes prolactinoma. In most cases, this condition appears spontaneously without any underlying conditions.
Even so, there are several factors that can increase the risk of prolactinoma, namely:
- Female gender
- 20–34 years old
- Suffering from an inherited genetic condition, namely multiple endocrine neoplasia type 1 (MEN 1)
Causes of increased prolactin hormone apart from prolactinoma
Apart from prolactinoma, there are several other conditions that can also make the production of the hormone prolactin excessive, namely:
- Medication side effects, such as antipsychotic drugs, high blood pressure medications, pain relievers, and nausea and vomiting medications
- Irritation and injury to the chest
- Herpes zoster in the chest area
- Pregnancy and breastfeeding
- The appearance of a tumor in the pituitary gland causing hyperpituitarism
- Underactive thyroid gland ( hypothyroidism )
- Kidney illness
Prolactinoma can occur without symptoms. New symptoms appear if the level of the hormone prolactin in the blood is excessive or there is pressure on the tissue around the tumor. Common symptoms include:
- Nausea and vomiting
- Pain or pressure in the facial area
- Visual impairment
- Impaired sense of smell
- Bones become brittle
- Decreased sexual desire
- Fertility problems
In addition to the general symptoms above, there are also specific prolactinoma symptoms felt by men or women. Symptoms of prolactinoma in women include:
- Pain during intercourse due to vaginal dryness
- Irregular menstruation or even no menstruation ( amenorrhea )
- Milk production when not breastfeeding
- Acne and hirsutism develop
Signs of prolactinoma tend to be recognized more quickly in women, for example when there is a change in menstrual patterns. Therefore, prolactinoma in women can be detected more when they are small.
In contrast to women, men often only become aware of the appearance of prolactinoma when the tumor has grown. Some of the symptoms of prolactinoma in men are:
- Erectile disorders
- Reduced body and facial hair growth
- Breast enlargement ( gynecomastia )
This disease can also be experienced by children and adolescents. Symptoms include disturbances in child development and delayed puberty.
When to see a doctor
Immediately do an examination to the doctor if you experience the symptoms above so that the cause can be ascertained.
Prolactinoma can cause pregnancy complications. Therefore, carry out routine prenatal checks to monitor the health of the mother and fetus during pregnancy, and prevent complications.
The following is the recommended pregnancy check -up schedule :
- 1 month before the 28th week
- Once every 2 weeks at week 28-35
- 1 once a week in the 36th week and until giving birth
More routine checks need to be done if you suffer from special health conditions or have had complications in previous pregnancies.
In diagnosing prolactinoma, the doctor will explore the patient's symptoms and medical history, as well as perform a physical examination. To confirm the diagnosis, the doctor will also carry out several supporting examinations, which include:
- Eye examination , to find out whether a tumor that grows in the pituitary gland causes vision problems or not.
- Brain scan, to get a clear picture of the condition of the brain, as well as the size and location of the tumor in the pituitary gland
- Blood test, to measure levels of prolactin and other hormones controlled by the pituitary gland
Treatment for prolactinoma aims to return prolactin levels and pituitary gland function to normal conditions, reduce the size of the tumor, relieve symptoms due to pressure caused by the tumor, such as visual disturbances and headaches, and improve the quality of life of sufferers.
If the tumor on the pituitary gland is not too large and the symptoms you are experiencing do not interfere with daily activities, the doctor can only monitor the patient's condition carefully through blood tests and scans if needed.
Meanwhile, to deal with large tumors, there are several types of treatment that can be done, namely:
In many cases, dopamine agonists , such as bromocriptine , are very effective at treating prolactinomas. Dopamine agonists function to normalize the function of the pituitary gland in producing prolactin and reduce tumor size.
Surgical procedures can also be done as an alternative if treatment with drugs doesn't work for the prolactinoma. There are two types of surgery used to treat prolactinoma, namely:
Transsphenoidal surgery Transsphenoidal surgery is performed to reach the pituitary gland through the sphenoid bone , by making a small incision over the front teeth or through the nostrils.
Transcranial surgery This
operation is performed on tumors that are large and have spread to the brain tissue, by reaching the pituitary gland through the skull bone.
If the use of drugs is unable to relieve the prolactinoma and surgery is not possible, the doctor will advise the patient to undergo radiation therapy or radiotherapy to remove the tumor.
Treatment of prolactinoma in pregnancy
If a prolactinoma sufferer is planning a pregnancy, it is advisable to consult a doctor first. If the patient is tested positive for pregnancy, the doctor will recommend stopping all use of drugs to prevent side effects on the fetus.
During pregnancy, prolactin levels in the blood will increase automatically so that the breasts can produce milk after delivery. An increase in the hormone prolactin makes the size of the pituitary gland increase, as well as prolactinoma tumors, especially if the tumor is large enough.
Enlarging the size of the tumor can cause symptoms, such as headaches and visual disturbances. If these symptoms appear, the doctor will advise the patient to return to using drugs to relieve symptoms and prevent prolactinoma complications.
After delivery, if the prolactinoma is small, the mother can breastfeed normally. However, if the prolactinoma is large enough, it is advisable to consult an endocrinologist before breastfeeding the baby to ensure safety.
Prolactinoma can cause several other health problems, namely:
High prolactin levels will inhibit the production of the hormones estrogen and testosterone. This can affect bone density and increase the risk of developing bone loss or osteoporosis .
If left without treatment, prolactinoma tumors can continue to grow and enlarge to the point of pressing on the nerves in the eye and causing visual disturbances.
Prolactinoma growth can interfere with the function of the pituitary gland in producing a number of other hormones that play a role in controlling growth, blood pressure, metabolism, and also reproduction. This condition is called hypopituitarism .
When pregnant, women will produce more estrogen hormone. In people with prolactinoma, excessive production of the hormone estrogen can trigger tumor development.
Because the exact cause of prolactinoma is not known, this condition is difficult to prevent. Prevention that can be done is only to avoid the risk of complications due to prolactinoma.
If you experience symptoms of prolactinoma or are at risk of developing prolactinoma, do an examination with a doctor so that the cause can be identified and treated appropriately.