Prolactinoma is the appearance of a benign brain tumor, precisely in the pituitary gland (pituitary gland).pituitary), which causes excessive production of the hormone prolactin. This condition can cause fertility problems in both men and women.
Prolactinoma occurs when some cells in the pituitary gland grow and develop excessively, thus forming a tumor. The growth of this tumor will result in the production of sex hormones (testosterone in men and estrogen in women) is reduced.
Based on the size, prolactinoma tumors are divided into three types, namely: microprolactinoma (less than 10mm), macroprolactinoma (more than 10 mm), and giant prolactinoma (more than 4 cm).
Symptoms of Prolactinoma
Prolactinomas 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:
- Headache
- Nausea and vomiting
- Fatigue
- Pain or pressure in the facial area
- Impaired vision
- Disturbed smell
- Bones become brittle
- Decreased sex drive
- Fertility problems
In addition to the general symptoms above, there are also specific prolactinoma symptoms that are felt by men or women. Symptoms of prolactinoma in women include:
- Pain during intercourse due to vaginal dryness
- Irregular menstruation
- Milk production when not breastfeeding
- Acne and hirsutism occur
Signs of prolactinoma tend to be recognized more quickly in women, for example when the sufferer notices a change in menstrual pattern. For this reason, prolactinomas in women are more detectable when they are small.
Unlike women, men often only realize the appearance of a 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 stunted child development and delayed puberty.
When to go to the doctor
If you feel the symptoms of prolactinoma as mentioned above, immediately do an examination to the doctor to determine the cause.
Prolactinomas can cause pregnancy complications. Therefore, carry out routine pregnancy checkups to monitor the health of the mother and fetus during pregnancy, and prevent complications.
The following is a recommended schedule for prenatal check-ups:
- Once a month before the 28th week.
- Every two weeks at 28-35 weeks.
- Once a week at 36 weeks and until delivery.
More routine checkups need to be done if you suffer from special health conditions or have experienced complications in a previous pregnancy.
Causes of Prolactinoma
It is not known what the exact cause of prolactinoma is. Most cases of prolactinoma arise spontaneously, without any specific underlying condition. There are several factors that can increase the risk of prolactinoma. These factors include age and gender, namely in women aged 20-34 years, as well as suffering from inherited genetic conditions, namely: multiple endocrine neoplasia type 1 (MEN 1).
Causes of increased prolactin hormones other than prolactinoma
In addition to prolactinoma, there are several other conditions that can also make the production of the hormone prolactin excessive, including:
- Side effects of drugs, such as antipsychotic drugs, high blood pressure medications, pain medications, and nausea and vomiting medications.
- Irritation and injury to the chest.
- Herpes zoster in the chest area.
- Pregnancy and breastfeeding.
- The appearance of a type of tumor in the pituitary gland.
- An underactive thyroid gland (hypothyroidism).
- Kidney illness.
Prolactinoma diagnosis
In diagnosing prolactinoma, the doctor will track the patient's symptoms and medical history, as well as perform a physical examination. To confirm the diagnosis, the doctor will also perform several supporting examinations, which include:
- Eye examination, to see if a tumor growing 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 tests, to measure levels of prolactin and other hormones controlled by the pituitary gland.
If necessary, the doctor will advise the patient to undergo a follow-up examination with an endocrinologist.
Prolactinoma Treatment
Prolactinoma treatment aims to restore prolactin levels and pituitary gland function to normal conditions, reduce tumor size, relieve symptoms due to pressure caused by the tumor, such as headaches and visual disturbances, and improve the patient's quality of life.
If the tumor in the pituitary gland is not too large and the symptoms experienced do not interfere with daily activities, treatment is enough to do with careful monitoring through blood tests, and scans if needed.
To treat large tumors, there are several types of treatment that can be done, including:
Drugs
In many cases, drugs dopamine agonists, such as bromocriptine, are very effective in treating prolactinomas. Drug dopamine agonists will normalize the function of the pituitary gland in producing prolactin and reduce tumor size.
Operation
Surgical procedures can also be performed as an alternative to medication dopamine agonists failed to treat prolactinoma. There are two types of surgery used to treat prolactinomas, namely:
- Operation transphenoidalThis surgery is done to reach the pituitary gland through the bone sphenoid. The doctor will make a small incision over the front teeth or through the nostrils.
- Operation ttranscranialThis operation is performed if the tumor is large and has spread to brain tissue. The doctor will reach the pituitary gland through the skull.
Radiotherapy
If the use of drugs is not able 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. When the patient is tested positive for pregnancy, the doctor will advise to stop 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. As a result of this increase, the size of the pituitary gland will also increase, as well as prolactinoma tumors, especially if the tumor is large enough.
The enlargement of the tumor size can cause symptoms, such as headaches and visual disturbances. If these symptoms appear, the doctor will advise you to return to using drugs to relieve symptoms and prevent complications from prolactinoma.
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 its safety.
Complications of Prolactinoma
Prolactinoma can cause several other health problems, namely:
- OsteoporosisHigh prolactin levels will inhibit the production of the hormones estrogen and testosterone. This also affects bone density and increases the risk of developing bone loss or osteoporosis.
- Visual disturbanceIf left untreated, prolactinoma tumors can continue to grow and enlarge until they press on the nerves in the eye and cause vision problems.
- HypopituitarismProlactinoma 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 reproduction. This condition is known as hypopituitarism.
- Disorders of pregnancyWhen pregnant, women will produce more estrogen hormone. In patients with prolactinoma, excessive production of the hormone estrogen can trigger tumor development.
Prolactinoma Prevention
Because the exact cause of prolactinoma is unknown, it is difficult to prevent this condition from occurring. Prevention that can be done is to prevent complications due to prolactinoma.
If you experience the symptoms of a prolactinoma as mentioned above or are at risk of developing a prolactinoma, do an examination with a doctor to find out the cause and get the right treatment.
