Materiały źródłowe

• #1 Prolactinoma – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/prolactinoma/diagnosis-treatment/drc-20376962

  If you have signs and symptoms that suggest you have a prolactinoma, your health care provider may recommend: […] Blood tests can show if too much prolactin is being made. They can also show whether levels of other hormones controlled by the pituitary gland are within the standard range. A pregnancy test is typically recommended for females of childbearing age. […] Your provider may be able to detect a prolactinoma using a magnetic resonance imaging (MRI) scan of your brain. […] These can determine if a prolactinoma is affecting your sight. […] Your provider may also refer you for additional testing with a specialist in treating disorders that affect the endocrine glands and hormones (endocrinologist).

• #2 Prolactinoma – NIDDK

  https://www.niddk.nih.gov/health-information/endocrine-diseases/prolactinoma

  How do doctors diagnose prolactinomas? […] Doctors diagnose prolactinomas based on the results of two tests […] Blood test. The prolactin blood test will measure the level of prolactin in your blood. If the level is too high, your doctor will order an imaging test to detect a possible tumor. […] Imaging tests. The preferred test is the magnetic resonance imaging (MRI) scan, which uses radio waves and magnets to create detailed images of your internal organs and soft tissues without x-rays. If an MRI is not a good option for you (for example, if you have a pacemaker or other implant that has metal), your doctor may order a computed tomography (CT) scan instead. The results of the imaging test usually will allow your doctor to confirm a diagnosis of prolactinoma and determine its size and location.

• #3 Prolactinoma Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/124634-workup

  Measure serum PRL levels on 1 or more occasions, especially if the elevation is modest. Do not measure the PRL level directly after performing a breast examination, because the breast examination may cause a physiological PRL elevation. […] Always consider the possibility of pregnancy in reproductive-aged females, because this is the most common cause of secondary amenorrhea in this group. […] Measure TSH levels to exclude the possibility of an elevated PRL level occurring secondary to an elevated TRH level. […] In a male presenting with symptoms of hypogonadism, measure serum testosterone or bioavailable testosterone levels. […] After performing biochemical testing, order a magnetic resonance imaging (MRI) scan of the pituitary hypothalamic area (with gadolinium enhancement) or a computed tomography (CT) scan of the region (with contrast) to determine if a mass lesion is present.

• #4 Prolactinoma – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/prolactinoma

  Prolactinomas are noncancerous tumors made up from lactotrophs in the pituitary gland. Diagnosis is by measurement of prolactin levels and imaging tests. […] Diagnosis of galactorrhea due to a prolactin-secreting pituitary adenoma is based on elevated prolactin levels (typically 5 times normal, sometimes much higher.) […] Prolactin levels correlate with the size of a pituitary tumor and can be used to follow patients over time. […] MRI with contrast is the method of choice in identifying microadenomas. High-resolution CT may be used when MRI is contraindicated or unavailable. […] Prolactin levels may rise in circulation as a consequence of renal insufficiency due to impaired renal clearance of prolactin. […] Measure prolactin levels and do central nervous system imaging to detect a causative tumor.

• #5 Diagnosis of prolactinoma – Pituitary Foundation

  https://www.pituitary.org.uk/information/prolactinoma-diagnosis/

  A prolactinoma is a prolactin-producing tumour of the pituitary gland. Diagnosis is straightforward and consists of blood test and scans. […] The tests to diagnose a prolactinoma are relatively straightforward. They consist of blood tests to check hormone levels and a scan of the pituitary gland to show the size of the prolactinoma. […] Your GP may carry out initial tests on your prolactin and thyroid levels. […] A further blood sample will be taken to make sure your thyroid gland is functioning normally. […] A scan is usually carried out to give detailed pictures of the pituitary gland. […] MRI is the scan of choice. […] If you have any problems with your vision, you will probably be seen by an eye specialist (opthalmologist) who will check the strength of your eyesight and chart your fields of vision. […] Sometimes an X-ray scan of your spine and hip bones (bone densitrometry) may be recommended to see whether there is any evidence of thinning of the bones (osteoporosis).

• #6 Prolactinoma: Symptoms, Diagnosis and Treatment

  https://patient.info/hormones/prolactinoma

  A prolactinoma occurs when some of the cells in the pituitary gland (the ones producing prolactin) multiply more than usual to form a small growth (tumour) in the pituitary gland. The diagnosis may be suspected from the symptoms. Women tend to be diagnosed earlier than men because a change in the woman’s periods is an early symptom and is easily noticed. If a prolactinoma is suspected, you may be offered several tests. The first test for women is a pregnancy test – prolactin goes up in pregnancy, and occasionally an undiagnosed pregnancy can be mistaken for a prolactinoma. A blood sample can check the level of prolactin in the blood. A very high prolactin level usually means that a prolactinoma is present. However, there are other causes of raised prolactin levels. Eye tests will assess if the tumour is pressing on the optic nerve – this includes a test of visual fields. A magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan can show the size of the tumour. Treatment usually works well to stop the symptoms of prolactinoma and to improve fertility. There are various options to treat prolactinomas but the usual treatment is medication. If you are choosing the no-treatment option, you may be advised to take oestrogen hormones (for women) or testosterone hormones (for men). Medication is a very effective treatment for most prolactinomas. The medication is a type called dopamine agonists. These act on the pituitary gland to reduce the amount of prolactin it makes, and they can also shrink the tumour. The outlook (prognosis) for most people with a prolactinoma is very good. Most prolactinomas are successfully treated with medication. If this does not work, surgery is usually successful. Prolactinomas can come back, even after successful treatment with medication or surgery. You will still need monitoring (such as regular blood tests) to check that the prolactinoma has not come back.

• #7 Clinical guidelines for diagnosis and treatment of prolactinoma and hyperprolactinemia | Endocrinología y Nutrición (English Edition)

  https://www.elsevier.es/en-revista-endocrinologia-nutricion-english-edition–412-articulo-clinical-guidelines-for-diagnosis-treatment-S2173509313001190

  Clinical guidelines for diagnosis and treatment of prolactinoma and hyperprolactinemia […] The document provides evidence-based practical and updated recommendations for diagnosis and management of hyperprolactinemia and prolactinoma, including drug-induced hyperprolactinemia, treatment options for prolactinoma (drugs, surgery, and radiotherapy), prolactinoma in pregnancy, adverse effects of dopaminergic agents, and drug-resistant and malignant prolactinomas. […] For most laboratories, normal serum PRL levels are less than 25ng/mL in women and less than 20ng/mL in men. […] As recommended by the most recent clinical guidelines, the measurement of PRL in a single sample is sufficient for diagnosis if vein puncture has not been traumatic. […] Dynamic tests (TRH, l-dopa, domperidone, etc.) have no advantage over basal PRL measurement, and are therefore not recommended.

• #8 Prolactinoma Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/124634-workup

  Good correlation exists between the size of the prolactinoma and the degree of elevation of the serum PRL. A serum PRL value of 200 ng/mL or greater in the presence of a macroadenoma (10 mm) is virtually diagnostic of prolactinoma. […] Repeat scans are obtained postoperatively and during follow-up examinations thereafter, or they are obtained after medical treatment to help determine if the tumor has progressed or regressed. […] When the tumor is large and is in close vicinity of the optic chiasm, formal visual-field (VF) testing by an ophthalmologist is performed prior to any therapy. […] If a pituitary/hypothalamic lesion other than a prolactinoma (such as lymphocytic hypophysitis or a granulomatous condition) is considered, biopsy of the lesion by a neurosurgeon may be indicated.

• #9 Identification of an optimal prolactin threshold to determine prolactinoma size using receiver operating characteristic analysis | Scientific Reports

  https://www.nature.com/articles/s41598-021-89256-7

  Prolactinomas represent the most common type of secretory pituitary neoplasms, with a therapeutic management that varies considerably based on tumour size and degree of hyperprolactinemia. […] The aim of the current study was to evaluate the relationship between serum prolactin (PRL) concentrations and prolactinoma size, and to determine a cut-off PRL value that could differentiate micro- from macro-prolactinomas. […] Baseline serum PRL concentrations were strongly correlated to tumour dimension (r=0.750, p=0.001). […] When performing the ROC curve analysis, the area under the curve was 0.976, indicating an excellent accuracy of the diagnostic method. […] For a value of 204 g/L (4338 mU/L), sensitivity and specificity were calculated at 0.932 and 0.891, respectively. […] After excluding other causes of elevated prolactin, imaging of the sellar region should be performed, with gadolinium enhanced pituitary magnetic resonance imaging (MRI) representing the gold standard radiological method for diagnosing prolactinomas.

• #10 Prolactinomas | Pituitary Network Association – International non-profit organization for patients with pituitary tumors and disorders

  https://pituitary.org/disorders/prolactinomas/

  These pituitary tumors (also called adenomas) secrete excessive amounts of prolactin and are the most common type of pituitary tumor seen clinically. Prolactin is the hormone that stimulates milk production by the breasts. Prolactin-producing tumors exist silently in up to 5-10% of the adult population. Prolactinomas generally have very different presentations in women and in men. […] The diagnosis of a prolactinoma is confirmed by demonstrating persistently elevated blood levels of prolactin. A prolactin level of over 150-200 ng/ml is almost always due to a prolactin secreting pituitary adenoma. In all patients with suspected pituitary tumors, a complete pituitary hormone evaluation should be performed. […] Most prolactinomas can be visualized on both MRI and CT scans of the pituitary gland. Such scans should be performed without and following contrast administration.

• #11 Pituitary Adenomas: An Overview | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0901/p319.html

  Prolactinomas and nonfunctioning adenomas are the most common types of pituitary adenomas. […] The diagnosis may also be made following imaging done for an unrelated issue in an asymptomatic patient; this is termed a pituitary incidentaloma. […] In the diagnostic approach to a suspected pituitary adenoma, it is important to evaluate complete pituitary function, because hypopituitarism is common. […] Serum prolactin level should be measured in all patients with signs or symptoms of pituitary adenoma. […] Evaluation of a suspected pituitary mass should include magnetic resonance imaging. […] Symptomatic prolactinomas and macroprolactinomas should be treated medically with dopamine agonists. […] Cabergoline is the preferred dopamine agonist for the treatment of prolactinomas. […] A higher serum prolactin level (250 mcg per L [10,870 pmol per L] or more) suggests a prolactinoma over other causes of hyperprolactinemia.

• #13 Identification of an optimal prolactin threshold to determine prolactinoma size using receiver operating characteristic analysis | Scientific Reports

  https://www.nature.com/articles/s41598-021-89256-7

  The aim of the current study was to evaluate the relationship between serum PRL concentrations and prolactinoma size, and to determine a cut-off PRL value that could reliably differentiate between micro- and macroadenomas before radiological assessment. […] ROC curve analysis was performed to determine a concentration of PRL that could reliably differentiate between micro- and macro- prolactinomas (Fig. 5). […] The area under the curve was 0.976, indicating an excellent accuracy of the diagnostic method. […] For a cut-off PRL concentration of 204 g/L (4338 mU/L), sensitivity and specificity were calculated at 0.932 and 0.891, respectively, with a Youden index of 82.3%. […] This study demonstrates for the first time that the degree of elevation of prolactin is a significant and useful parameter in predicting the size of the prolactinoma providing a reference prolactin concentration. […] When a cut off PRL value of 204 g/L (4338 mU/L) was used, specificity was calculated as 93.2%, and sensitivity as 89.1% in distinguishing a macro-adenoma from the more common micro-adenoma.

• #14 Prolactinomas and nonfunctioning adenomas: preoperative diagnosis of tumor type using serum prolactin and tumor size in: Journal of Neurosurgery Volume 133 Issue 2 (2019) Journals

  https://thejns.org/view/journals/j-neurosurg/133/2/article-p321.xml

  Prolactinoma and nonfunctioning adenoma (NFA) are the most common sellar pathologies, and both can present with hyperprolactinemia. There are no definitive studies analyzing the relationship between the sizes of prolactinomas and NFAs and the serum prolactin level. Current guidelines for serum prolactin level cutoffs to distinguish between pathologies are suboptimal because they fail to consider the adenoma volume. In this study, the authors attempted to describe the relationship between serum prolactin level and prolactinoma volume. They also examined the predictive value that can be gained by considering tumor volume in differentiating prolactinoma from NFA and provide cutoff values based on a large sample of patients. […] A strong correlation was found between prolactinoma volume and serum prolactin level (r = 0.831, p 0.001). However, there was no significant correlation between NFA volume and serum prolactin level (r = 0.020, p = 0.773).

• #15 Prolactinomas and nonfunctioning adenomas: preoperative diagnosis of tumor type using serum prolactin and tumor size in: Journal of Neurosurgery Volume 133 Issue 2 (2019) Journals

  https://thejns.org/view/journals/j-neurosurg/133/2/article-p321.xml

  The data presented here show a relationship between prolactinoma volume and serum prolactin level that has not been previously described. We found a strong correlation between prolactinoma volume and serum prolactin level (r = 0.831, p 0.001), although there was no significant correlation between NFA volume and serum prolactin level (p = 0.733). These two findings together indicate that the presence of prolactin-producing tissue is a more important factor in the serum prolactin level than absolute adenoma volume. […] Prolactinoma volume has a significant impact on the serum prolactin level, but NFA volume has much less of an impact on the serum prolactin level; therefore, volume should be accounted for in cutoff guidelines. Currently recommended cutoffs around 200250 g/L are likely appropriate for tumors larger than 4 cm3 (group 3) but are not accurate for smaller macroadenomas or microadenomas. Prolactinomas smaller than 4 cm3 (groups 1 and 2) are less likely to produce enough prolactin to exceed 200250 g/L, leading to the potential for misdiagnosis as an NFA if these cutoffs are used.

• #16 Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-023-00886-5

  Prolactin secretion is under chronic inhibitory control by hypothalamus-derived dopamine. […] The most common pathological cause of hyperprolactinaemia is excess prolactin production by a prolactinoma. […] However, parasellar or intrasellar masses impinging on the pituitary stalk, including non-secreting pituitary adenomas, can compromise dopamine flow and cause hyperprolactinaemia. […] Prolactin is usually measured by immunoassay, calibrated against the WHO 84/500 international standard containing exclusively 23kDa monomeric human prolactin. […] MRI should be performed in patients with confirmed hyperprolactinaemia at diagnosis, to demonstrate pituitary adenoma response to medical treatment, and to establish baseline status 36 months after surgery. […] Follow-up imaging frequency should be based on clinical, biochemical and histological factors, as well as previous imaging results.

• #17 Prolactinoma: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/124634-overview

  Prolactinomas can be assessed through hormone testing and magnetic resonance imaging (MRI) or computed tomography (CT) scanning. […] Treatment is indicated if mass effects from the pituitary tumor and/or significant effects from hyperprolactinemia are present. […] After performing biochemical testing, order a magnetic resonance imaging (MRI) scan of the pituitary hypothalamic area (with gadolinium enhancement) or a computed tomography (CT) scan of the region (with contrast) to determine if a mass lesion is present. […] Transsphenoidal pituitary adenomectomy is the preferred surgical treatment in patients with microprolactinomas and in most patients with macroprolactinomas. […] Bromocriptine (BEC) is generally considered to be the agent of choice in the treatment of prolactinomas because of its long track record and safety.

• #18 Prolactinoma – Symptoms, Diagnosis, TreatmentSecond Opinion Iconphone iconSecond Opinion IconGroup 49

  https://www.barrowneuro.org/condition/prolactinoma/

  After these two procedures, other diagnostic tests may be enlisted, like a visual field test to check for optic nerve compression or a bone densitometry scan to look for evidence of osteoporosis. […] Doctors classify prolactinomas by their size. A microprolactinoma is a tumor less than 1 cm in diameter that generally responds to treatment. A macroprolactinoma is a tumor greater than 1 cm in diameter that responds to treatment but may require more aggressive therapy.

• #19 Prolactinoma: Symptoms, Surgery, Treatment

  https://www.medicinenet.com/prolactinoma/article.htm

  Magnetic resonance imaging (MRI) is the most sensitive test for detecting and measuring prolactinomas. MRI scans may be repeated periodically to assess tumor progression and the effects of therapy. Computer tomography (CT scan) also provides an image of the pituitary, but it is less sensitive than the MRI for the detection of prolactinoma.

• #20 Prolactinoma – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/363

  Prolactinomas represent approximately 50% of all pituitary adenomas, with a female preponderance. […] Women usually present with amenorrhea and galactorrhea. Men may present with sexual dysfunction, hypogonadism, and sometimes gynecomastia, all related to the hyperprolactinemia. […] Premenopausal women present earlier due to menstrual irregularity and hence usually have microprolactinomas. Men and postmenopausal women often present later with macroadenomas, which may be invasive or giant tumors. […] Treatment with dopamine agonists usually results in prolactin normalization, symptom improvement, and tumor shrinkage. […] Key diagnostic factors include amenorrhea or oligomenorrhea, infertility, galactorrhea, loss of sexual desire (libido), erectile dysfunction, and visual deterioration (e.g., temporal hemianopia). […] 1st tests to order include serum prolactin, pituitary MRI, and computerized visual-field examination.

• #21 Prolactinoma: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22007-prolactinoma

  If you receive a prolactinoma diagnosis, your provider may recommend additional blood tests to check the levels of other pituitary hormones. […] Prolactinoma surgery is also often successful. When an experienced surgeon performs the surgery, it corrects prolactin levels in about 90% of people with small tumors and in 50% of those who have large tumors.

• #22 Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-023-00886-5

  Loss of libido and/or infertility, new-onset menstrual irregularities or amenorrhoea in women, as well as erectile dysfunction and/or hypogonadotrophic hypogonadism in men, should trigger investigation for hyperprolactinaemia. […] Macroprolactinomas and, less frequently, microprolactinomas can cause growth hormone (GH), thyroid-stimulating hormone (TSH) and adrenocorticotrophic hormone (ACTH) axis deficiencies. […] Patients should be evaluated for associated clinical features, tested for pituitary hormone deficiencies and appropriately treated per standard guidelines. […] Patients with hyperprolactinaemia but serum levels of prolactin less than five times the upper limit of normal (ULN) should undergo repeat prolactin testing. […] In general, pituitary adenoma size and serum levels of prolactin correlate; discrepancy should trigger consideration of other possible causes.

• #23 Pituitary Adenomas: An Overview | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0901/p319.html

  A serum prolactin level greater than 500 mcg per L (21,739 pmol per L) is diagnostic for a macroprolactinoma (98% specificity). […] The Endocrine Society’s 2011 clinical practice guidelines for pituitary incidentalomas recommend a complete assessment of pituitary function, even if the patient is asymptomatic. […] Most patients do not require surgical intervention, although prospective biochemical monitoring and repeated imaging are recommended by expert panel guidelines. […] The majority of prolactinomas can be managed medically with dopamine agonists. […] By inhibiting the release of prolactin from the anterior pituitary, these medications resolve hyperprolactinemia symptoms, reduce tumor size, and often restore reproductive function.

• #24 Prolactinoma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459347/

  Hyperprolactinemia is not always due to prolactinoma, and other causes like pregnancy, drugs, hypothyroidism, and pituitary stalk effect due to other pituitary tumors should be considered in the differential. […] An extensive history and physical examination are needed to exclude other causes of hyperprolactinemia and to document any visual field deficits, galactorrhea, growth changes, hypopituitarism, menstrual irregularities, impotence, infertility. […] The test begins with serum prolactin level. […] If the prolactin level is high, a comprehensive metabolic panel, TSH, and a pregnancy test (for women of childbearing age) should be obtained. […] Macroprolactinoma or symptomatic microadenoma should be treated with dopamine agonist therapy. […] The goals of treatment would be tumor shrinkage, restoration of visual fields if any defect, reversal of galactorrhea, and restoration of fertility or abnormal sexual function.

• #25 Prolactinoma Diagnosis And Treatment – Klarity Health Library

  https://my.klarity.health/prolactinoma-diagnosis-and-treatment/

  Medication review should be done to exclude any drug-induced hyperprolactinemia. Renal impairment, primary hypothyroidism, and liver failure should be considered as causes of mild hyperprolactinemia. Overall, pituitary tumour size and prolactin levels are strongly correlated to hyperprolactinemia and prolactinoma. Pregnancy is excluded from the causes of hyperprolactinemia. […] MRI plays an essential role in hyperprolactinemia management through confirming the diagnosis of pituitary adenoma and thus saving time for treatment and follow-ups. […] Dopamine agonists are the first line of treatment for prolactinoma. […] In case the patient is refractory to all dopamine agonists, surgery is considered, and if surgery fails as well, radiotherapy can be an alternative.

• #26 Prolactin Levels Test: High vs. Low, Normal Range

  https://www.webmd.com/a-to-z-guides/prolactin-test

  A prolactin (PRL) blood test measures how much of a hormone called prolactin you have in your blood. […] If your levels are very high — up to 1,000 times the upper limit of whats considered normal — this could be a sign that you have prolactinoma — a tumor in your pituitary gland. […] If your prolactin levels are below the normal range, this could mean your pituitary gland isnt making one or more of the hormones it normally does, sometimes due to an injury to the gland. […] Your doctor may order a prolactin test when you report having the following symptoms: […] A high level of prolactin can lead to infertility. A level up to 1,000 times the upper limit of whats considered normal could be a sign that you have a noncancerous tumor called a prolactinoma. It is usually treated with medication.

• #27 Patient education: High prolactin levels and prolactinomas (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/high-prolactin-levels-and-prolactinomas-beyond-the-basics

  Prolactinoma is diagnosed based on an elevated blood level of prolactin and evidence of a mass in the pituitary gland, as seen by magnetic resonance imaging (MRI). […] The prolactin level can be measured in a single blood sample. […] MRI is the best test for identifying masses in or near the pituitary gland, although MRI cannot determine if the mass is a pituitary adenoma or another abnormality. […] Some of the medications that are used to treat psychiatric conditions can cause high blood prolactin levels. […] The goals of treatment are to lower the level of prolactin in the blood to normal and to decrease the size of a large adenoma, especially if it is compressing surrounding structures. […] Not all prolactinomas require treatment. […] When treatment is necessary, most prolactinomas respond well to therapy with medications called dopamine agonists.

• #28 Patient education: High prolactin levels and prolactinomas (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/high-prolactin-levels-and-prolactinomas-beyond-the-basics/print

  Prolactinoma is diagnosed based on an elevated blood level of prolactin and evidence of a mass in the pituitary gland, as seen by magnetic resonance imaging (MRI). […] The prolactin level can be measured in a single blood sample. The result can range from slightly elevated to a thousand times the upper limit of normal. In general, larger adenomas cause higher prolactin levels. […] MRI is the best test for identifying masses in or near the pituitary gland, although MRI cannot determine if the mass is a pituitary adenoma or another abnormality. Furthermore, some small adenomas (microadenomas) cannot be detected by MRI, and not all adenomas secrete prolactin or other hormones. […] Some of the medications that are used to treat psychiatric conditions can cause high blood prolactin levels. Other causes of high prolactin include high doses of female sex hormones (estrogens) and underactivity of the thyroid gland (hypothyroidism).

• #29 Clinical guidelines for diagnosis and treatment of prolactinoma and hyperprolactinemia | Endocrinología y Nutrición (English Edition)

  https://www.elsevier.es/es-revista-endocrinologia-nutricion-412-articulo-clinical-guidelines-for-diagnosis-treatment-S2173509313001190

  The first steps in differential diagnosis in a patient with hyperprolactinemia include a thorough clinical history aimed at detecting potential secondary causes of hyperprolactinemia (including drug use) and a complete physical examination. […] For any hyperprolactinemia of unknown cause, pituitary magnetic resonance imaging (MRI) with gadolinium should be performed. […] The imaging test indicated for pituitary lesions is MRI. […] The recommended timing of imaging tests is discussed in the section Treatment monitoring. […] The treatment of drug-induced hyperprolactinemia should be restricted to symptomatic patients in whom the concerned drug cannot be discontinued or replaced. […] We usually recommend transsphenoidal surgery when treatment with dopamine agonists does not decrease PRL levels or macroadenoma size. […] Surgical cure rates range from 75% to 90% for microadenomas and from 18% to 80% for macroadenomas. […] The efficacy of radiotherapy should always be weighed against the complications derived from the treatment.

• #30 Clinical guidelines for diagnosis and treatment of prolactinoma and hyperprolactinemia | Endocrinología y Nutrición (English Edition)

  https://www.elsevier.es/es-revista-endocrinologia-nutricion-412-articulo-clinical-guidelines-for-diagnosis-treatment-S2173509313001190

  Clinical guidelines for diagnosis and treatment of prolactinoma and hyperprolactinemia […] The document provides evidence-based practical and updated recommendations for diagnosis and management of hyperprolactinemia and prolactinoma, including drug-induced hyperprolactinemia, treatment options for prolactinoma (drugs, surgery, and radiotherapy), prolactinoma in pregnancy, adverse effects of dopaminergic agents, and drug-resistant and malignant prolactinomas. […] For most laboratories, normal serum PRL levels are less than 25ng/mL in women and less than 20ng/mL in men. […] As recommended by the most recent clinical guidelines, the measurement of PRL in a single sample is sufficient for diagnosis if vein puncture has not been traumatic. […] Dynamic tests (TRH, l-dopa, domperidone, etc.) have no advantage over basal PRL measurement, and are therefore not recommended.

• #31 Prolactinoma: Early Detection, Evaluation and Management – The ObG Project

  https://www.obgproject.com/2017/04/18/prolactinoma-early-detection-evaluation-and-management/

  Prolactinomas are generally benign prolactin-secreting tumors and account for 40-66% of all pituitary adenomas. The vast majority are microadenomas (diameter < 1cm) and suppress the hypothalamic-pituitary gonadal hormonal axis, while 10% are macroadenomas (≥ 1cm) and may cause additional mass effects due to size. [...] Despite their benign nature, if diagnosis is delayed bone loss and vertebral fractures can occur, and the loss of bone density can be permanent. [...] Evaluation: [...] To establish the diagnosis of hyperprolactinemia, we recommend a single measurement of serum prolactin; a level above the upper limit of normal confirms the diagnosis as long as the serum sample was obtained without excessive venipuncture stress. [...] Prolactin levels above 200 µg/L is usually a prolactinoma. [...] Prolactin levels above 500 µg/L likely indicates a macroprolactinoma. [...] Prolactin macroadenomas can present with a falsely normal prolactin level due to the “hook effect” (false negative levels if excessive amount of analyte is present).

• #32 Diagnosis and Treatment

  https://edm.bioscientifica.com/cases/diagnosis-treatment?access=open&t=signs-symptoms_760&t_0=signs-symptoms_601

  Prolactinomas constitute the largest subsection of all secretory pituitary adenomas. Most are microprolactinomas and are satisfactorily treated by medical management alone. Giant prolactinomas, measuring more than 4cm in diameter, are rare and usually occur more commonly in men. Macroprolatinomas tend to present with symptoms of mass effect rather than those of hyperprolactinaemia. Dopamine agonists (DA) are the treatment of choice for all prolactinomas. Surgery is usually reserved for DA resistance or if vision is threatened by the mass effects of the tumour. […] Treatment of giant invasive prolactinomas may involve a combination of medical management and multiple surgical interventions. […] A sub occipital transtetorial approach may be considered the treatment of choice in invasive prolactinomas compressing the brainstem. […] Multidisciplinary approach of such patients is fundamental for a better outcome.

• #33 Update in Pathogenesis, Diagnosis, and Therapy of Prolactinoma

  https://www.mdpi.com/2072-6694/14/15/3604

  Prolactinomas comprise 30–50% of all pituitary neuroendocrine tumors, frequently occur in females aged 20 to 50, and cause hypogonadism and infertility. […] During diagnosis, other causes of hyperprolactinemia must be excluded, and an MRI is useful for detecting pituitary neuroendocrine tumors. […] Prolactinoma is diagnosed by imaging tests, such as magnetic resonance imaging (MRI), which detects PitNETs. […] After hyperprolactinemia is confirmed, various differential diagnoses should be made, including prolactinoma, medications that cause hyperprolactinemia, or organic diseases in the hypothalamic/pituitary region. […] When prolactinoma is suspected, MRI imaging is warranted. […] In prolactinomas, tumor volume usually correlates with serum PRL levels. […] The bromocriptine loading test is helpful for predicting the effectiveness of DA, as it suppresses PRL to more than half the basal value.

• #34 Prolactinoma (pituitary tumor) – USZ

  https://www.usz.ch/en/disease/prolactinoma/

  A prolactinoma is a generally benign tumor of the pituitary gland. […] The correct interpretation of an elevated prolactin level and the diagnosis of prolactinoma can be difficult in individual cases. […] In order to diagnose a prolactinoma, we will first take your medical history (anamnesis). […] If a prolactinoma is suspected, it is important to measure the prolactin level in the blood. […] To confirm the suspicion of a prolactinoma, we carry out a magnetic resonance imaging (MRI) scan after an abnormal blood test. […] An important task in the diagnosis of a prolactinoma is to rule out other causes of an elevated prolactin level. […] As a prolactinoma often leads to menstrual cycle disorders, it is usually detected earlier in women than in men. […] Despite successful treatment, a prolactinoma can sometimes recur (recurrence). […] If the prolactinoma is very small and does not cause any symptoms, there is usually no treatment.

• #35 Prolactinoma – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/prolactinoma/symptoms-causes/syc-20376958

  Complications of prolactinoma may include: […] A prolactinoma can interfere with reproduction. Too much prolactin reduces the production of the hormones estrogen and testosterone. Too much prolactin also can prevent the release of an egg during the menstrual cycle (anovulation) in females. In males, too much prolactin also can lead to decreased sperm production. […] Left untreated, a prolactinoma may grow large enough to press on your optic nerve.

• #36 Prolactinoma – NIDDK

  https://www.niddk.nih.gov/health-information/endocrine-diseases/prolactinoma

  After confirming the prolactinoma diagnosis, your doctor may conduct other tests to find out if the tumor is affecting other hormones. Depending on the tumors size, your doctor may also ask you to take a vision test. […] How do doctors treat prolactinomas? […] Doctors commonly treat prolactinomas with medicines. More rarely, surgery or radiation therapy may be used. The goals of treatment are to bring prolactin levels back to normal, shrink the tumor, make sure the pituitary gland is working properly, and correct any problems caused by the tumor, such as menstrual problems, milky discharge from the breasts, low testosterone levels, headaches, or vision problems. […] Medicines called dopamine agonists control prolactin levels and shrink the tumor very effectively. […] Two dopamine agonists are most commonly used to treat prolactinomas: bromocriptine, a drug that must be taken twice or three times daily, and cabergoline, a drug that can be taken once or twice per week.

• #37 Update in Pathogenesis, Diagnosis, and Therapy of Prolactinoma

  https://www.mdpi.com/2072-6694/14/15/3604

  The goals of prolactinoma treatment are to counteract hypogonadism by suppressing hyperprolactinemia and decreasing the size of the tumor. […] Pharmacotherapy is the first-line treatment for prolactinomas, and dopamine agonists (DAs) represent the primary therapy for almost all prolactinomas, including microtumors (less than 1 cm in diameter, macrotumors (greater than 1 cm), or giant tumors (greater than 4 cm). […] DAs, such as bromocriptine or cabergoline, are highly effective in suppressing PRL secretion and reducing tumor size. […] If the response to DAs is insufficient, surgical treatment should be considered to debulk the tumor volume, which may improve postoperative medical control. […] The common indications for surgery in prolactinomas are resistance or intolerance to DA or the failure of the maximum dose of DA to lower the PRL or reduce tumor volume in macroprolactinomas.

• #38 Prolactinoma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459347/

  Most prolactinomas are managed with medical therapy only with surgery and radiotherapy reserved for refractory cases. […] Unlike other pituitary tumors, the preferred treatment for prolactinomas is medical therapy. […] Specific treatment for prolactinomas is one of the dopamine agonists. […] Treatment with dopamine agonist should be tapered and stopped if prolactin level is normal and the tumor is not visible in MRI after at least two years of treatment. […] Transsphenoidal surgery is the preferred surgical option if surgery is indicated for the following reasons: Unsuccessful medical therapy to lower prolactin level and decrease tumor size after several months of maximum dose. […] The majority of patients with microprolactinomas have an excellent prognosis. […] Macroprolactinomas, on the other hand, can grow over time and require more aggressive treatment.

• #39 Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-023-00886-5

  Surgical resection of microprolactinomas and well-circumscribed macroprolactinomas (Knosp grade 0 and 1) by an experienced neurosurgeon offers a high chance of cure, is cost-effective and avoids long-term dopamine agonist treatment. […] Dopamine agonist therapy is highly effective at lowering serum levels of prolactin, improving clinical consequences of hyperprolactinaemia and reducing adenoma size. […] Cabergoline is the preferred dopamine agonist owing to its long half-life, high efficacy and good tolerability. […] Patients with prolactinoma of Knosp grade 2 should be treated with cabergoline. […] Patients with resistance or intolerability to other dopamine agonist therapy should be switched to cabergoline. […] As approximately one-fifth of patients can remain in remission after discontinuing cabergoline, patients should be evaluated for favourable predictors, and dose reduction or treatment withdrawal should be considered at regular intervals.

• #40 Diagnosis and Management of Galactorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0801/p543.html

  Bromocriptine is the drug of choice when treatment is aimed at hyperprolactin-induced anovulatory infertility. […] Cabergoline is significantly more effective than bromocriptine in normalizing serum prolactin levels and restoring gonadal function. […] Because of the inherent risks of surgery and the efficacy of dopamine agonists in treating patients with prolactinoma, surgical resection rarely is required.

• #41 Prolactinoma – NIDDK

  https://www.niddk.nih.gov/health-information/endocrine-diseases/prolactinoma

  Cabergoline is the preferred drug for treating prolactinomas, because it is more effective than bromocriptine and has fewer side effects. […] For most small prolactinomas, dopamine agonists bring prolactin levels back to normal and shrink tumors in 4 out of 5 patients. […] Although doctors most often treat prolactinomas with medicines, in some cases surgery may be an option. […] The success of the surgery depends on many factors, including the skill and experience of the surgeon and the size and location of the tumor. […] When done by an experienced surgeon, the surgery corrects prolactin levels in about 90 percent of people with small tumors and 50 percent of those with large tumors. […] More rarely, if medicines and surgery fail to reduce prolactin levels, radiation therapy may be used. […] Prolactin levels return to normal in 1 out of 3 patients treated with radiation therapy. […] Your doctor is likely to prescribe medicines while you wait to see results.

• #42 Prolactinoma Symptoms & Treatment | PNI Pituitary Disorders

  https://www.pacificneuroscienceinstitute.org/pituitary-disorders/conditions/pituitary-adenomas/prolactinoma/

  Prolactinomas are common pituitary adenomas that cause excess prolactin production. […] To confirm a pituitary tumor, particularly a prolactinoma, healthcare providers use several diagnostic tests. First, a blood test measures the levels of prolactin, a hormone often elevated in individuals with prolactinomas. Consistently high prolactin levels suggest the presence of this type of tumor. […] Prolactinomas are typically diagnosed because of problems related to high blood prolactin levels and associated hypogonadism (low sex hormones) and weight gain. A prolactin level of over 150-200 ng/ml is almost always due to a prolactinoma. […] Prolactinomas can best be visualized on a pituitary MRI performed with and without Gadolinium. […] In general, first line treatment for patients with a prolactinoma is medication rather than endonasal surgery. Approximately 80-85% of patients will have prolactin levels restored to normal with dopamine agonist therapy and many will have marked tumor shrinkage.

• #43 Patient education: High prolactin levels and prolactinomas (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/high-prolactin-levels-and-prolactinomas-beyond-the-basics

  If the prolactin level remains normal and no tumor is seen on magnetic resonance imaging (MRI) for two or more years, a trial period without medication can be considered. […] If the dopamine agonist is not effective in lowering the prolactin level, or if the person cannot tolerate the side effects, surgery to attempt to remove the adenoma may be considered. […] Surgery is an option when dopamine agonists are ineffective or not tolerated. […] Surgery can often reduce the blood prolactin concentration, sometimes to normal. […] Radiation therapy can shrink prolactinomas and lower blood prolactin levels, but these effects usually take several years.

• #44 Clinical guidelines for diagnosis and treatment of prolactinoma and hyperprolactinemia | Endocrinología y Nutrición (English Edition)

  https://www.elsevier.es/en-revista-endocrinologia-nutricion-english-edition–412-articulo-clinical-guidelines-for-diagnosis-treatment-S2173509313001190

  For any hyperprolactinemia of unknown cause, pituitary magnetic resonance imaging (MRI) with gadolinium should be performed. […] The first steps in differential diagnosis in a patient with hyperprolactinemia include a thorough clinical history aimed at detecting potential secondary causes of hyperprolactinemia (including drug use) and a complete physical examination. […] The imaging test indicated for pituitary lesions is MRI. […] The recommended timing of imaging tests is discussed in the section Treatment monitoring. […] The treatment of drug-induced hyperprolactinemia should be restricted to symptomatic patients in whom the concerned drug cannot be discontinued or replaced. […] We usually recommend transsphenoidal surgery when treatment with dopamine agonists does not decrease PRL levels or macroadenoma size. […] Surgical cure rates range from 75% to 90% for microadenomas and from 18% to 80% for macroadenomas. […] The efficacy of radiotherapy should always be weighed against the complications derived from the treatment.

• #45 Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-023-00886-5

  This Consensus Statement from an international, multidisciplinary workshop sponsored by the Pituitary Society offers evidence-based graded consensus recommendations and key summary points for clinical practice on the diagnosis and management of prolactinomas. […] In-depth discussions present the latest evidence on treatment of prolactinoma, including efficacy, adverse effects and options for withdrawal of dopamine agonist therapy, as well as indications for surgery, preoperative medical therapy and radiation therapy. […] The workshop concluded that, although treatment resistance is rare, there is a need for additional therapeutic options to address clinical challenges in treating these patients and a need to facilitate international registries to enable risk stratification and optimization of therapeutic strategies.

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