Hyperprolactinemia and Prolactinoma

Prolactinoma is a benign (noncancerous) tumor of the pituitary gland that causes hyperprolactinemia. It is the most commonly diagnosed tumor type in the pituitary gland that affects hormone production.  

Prolactinoma causes a condition called hyperprolactinemia. Hyperprolactinemia is characterized by an increased production of the hormone prolactin. Prolactin, produced by the pituitary gland and known for its role in lactation in women, has been found to contribute to more than 300 functions in the body.

Causes of Hyperprolactinemia/Prolactinoma

The cause of prolactinoma is unknown. This tumor most commonly develops in individuals under the age of 40. It is significantly more common in women than men, and is very rare in children.  

Hyperprolactinemia, if not caused by prolactinoma, can also develop due to:  

  • Certain medications such as medications for depression, high blood pressure, and heartburn
  • Other types of pituitary tumors
  • Hypothyroidism (underactive thyroid)
  • Pregnancy and/or breastfeeding

Symptoms of Hyperprolactinemia/Prolactinoma

If the tumor grows, it may place pressure on the brain and cause:  

  • Headache
  • Fatigue
  • Nausea and/or vomiting
  • Nasal drainage accompanied by complications with sense of smell
  • Visual disturbances such as drooping eyelid or double vision  

Prolactinoma in women may cause: 

  • Infertility and changes in the menstrual cycle
  • Milky discharge from the breasts (when not breastfeeding)
  • Vaginal dryness
  • Acne
  • Excess growth in body and facial hair

Prolactinoma in men may cause:

  • Erectile dysfunction
  • Enlargement of the breasts
  • Decreased muscle mass
  • Decreased facial and body hair

If you develop signs or symptoms associated with prolactinoma and/or hyperprolactinemia, make an appointment to see your doctor.

What to Expect at Your Appointment

During your appointment, your doctor will ask you questions regarding your symptoms and will perform a physical examination. If your doctor suspects hyperprolactinemia, he/she will prescribe a blood test in order to measure the amount of prolactin in the blood. This test will also analyze the levels of other hormones produced by the pituitary gland and will allow your doctor to check for other possible causes of your symptoms.  

An MRI scan or a CT scan may be used to detect a possible tumor in the pituitary gland.  Your doctor may request that you get a vision test to determine if the tumor is affecting your eyesight.  

Diagnosing hyperprolactinemia and/or prolactinoma may take some time, and you may be referred to different types of doctors, such as an endocrinologist and/or an oncologist, in order to determine an accurate diagnosis.  

Non-surgical Treatments for Hyperprolactinemia/Prolactinoma

Treatment for hyperprolactinemia will be determined based on the cause of the condition. If excess prolactin does not cause any symptoms, then treatment may not be necessary. Treatment options for hyperprolactinemia caused by prolactinoma include:

  • Medication to decrease prolactin production
  • Surgery to remove the prolactinoma
  • Radiation, if the entire tumor cannot be removed, in order to shrink the tumor

Surgical Treatment for Hyperprolactinemia/Prolactinoma and Post-Treatment

When medications are not effective, or if the tumor is affecting vision, surgical intervention may be required to remove the prolactinoma.  

The type of surgery performed will depend on the size, extent, and location of the tumor. The prolactinoma can be removed using one of two techniques:  

  • Transsphenoidal surgery - The tumor is removed through the nasal cavity using endoscopic techniques.
  • Transcranial surgery - The tumor is removed through the skull using open surgical techniques.  

Achieving the best outcome from hyperprolactinemia treatment requires a comprehensive, multidisciplinary approach that involves a highly-skilled team of experts. MedStar Washington Hospital Center is the only multidisciplinary pituitary center of its kind in the Washington, DC, area.

“[We are proud to have] over 50 years of combined expertise and more pituitary surgeries than any other hospital in the region." - Dr. Edward Fiore Aulisi, Chairman of the Department of Neurosurgery &  Medical Director of the MedStar Neuroscience Intermediate Care Unit  

The pituitary center at MedStar Washington allows patients to schedule office visits, diagnostic testing, and surgery with a team of neurosurgeons experienced with pituitary disorders, a pituitary endocrinologist, a neuro ophthalmologist, and an otolaryngologist - all in the same location.  

Outlook and Prognosis for Individuals With Hyperprolactinemia/Prolactinoma  

Prolactin levels before surgery will most likely indicate the likelihood that the hyperprolactinemia will resolve after removal of the tumor. The higher prolactin levels are, the less likely it is that they will return to normal after surgery.

 If surgical intervention is required, prognosis typically depends on the size and location of the tumor. If the tumor is small, surgery typically corrects the accompanying hyperprolactinemia. However, many prolactinoma tumors return within five years of surgery. For this reason, it is extremely important to schedule and attend all follow-up appointments recommended by the physician in order to monitor for prolactinoma recurrence.