8/16/2016 AM Report – Prolactinoma

Remember common causes of elevated prolactin:
Physiologic: Pregnancy, Lactation
Medications: Anti-psychotic agents, metoclopramide, verapamil, methyldopa, cocaine, many more
Other: Prolactinoma, hypothyroidism, cirrhosis, CKD

Pituitary tumors:
Microadenoma: <1 cm – more common in females
Macroademona: >1 cm – more common in males
* 10% of general population have undiagnosed pituitary adenoma on autopsy
* 10-38% have incidental microadenoma and 0.2% have incidental macroadenoma on MRI brain
Most pituitary adenomas (40%) are prolactinomas

Sellar mass differential:
– Pituitary adenoma
– Metastatic disease
– Sarcoidosis
– Rathke’s cleft cyst
– Infection
– CNS lymphoma
– Craniopharyngioma
– Meningioma
– Circle of Willis aneurysm
– Hemochromatosis

Remember the hormones of the anterior/posterior pituitary:

Remember the visual field deficits and their corresponding location/lesion:

Treatment of Prolactinoma: CAN BE TREATED MEDICALLY!
1. Dopamine agonist (bromocriptine, carbergoline)
2. Transphenoidal surgery – reserved for those who do not respond or demonstrate slow progression with medical therapy
3. Radiation – used to prevent regrowth of residual tumor

Indications for treatment:
1. Neurological symptoms
2. Evidence of hypogonadism

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