A prolactinoma is the most common hormone-making pituitary tumor, and it releases too much prolactin. High prolactin shuts down the reproductive hormones, so women often present early with period changes, while men usually present later with larger tumors.
Key symptoms
- Missed or absent periods and infertility
- Milky discharge from the nipples
- Low libido and erectile dysfunction in men
- Headache and vision changes with large tumors
- Bone loss over time
What you find on exam
- Galactorrhea on gentle breast exam
- Visual fields by confrontation
- Breast tissue in men
- Signs of low estrogen or testosterone
- Medication review for drugs that raise prolactin
Tests
- Serum prolactin, usually very high with large tumors
- Pregnancy test, TSH and kidney function to exclude other causes
- Pituitary MRI
- Other pituitary hormones and formal visual fields if the tumor is large
Treatment basics
- Dopamine agonist: cabergoline is first line
- Bromocriptine as an option, often preferred when planning pregnancy
- Surgery if drugs fail or are not tolerated
- Some small tumors without symptoms can simply be watched
- Monitor prolactin and MRI; check fertility and bone health
Red flags
- Sudden severe headache with vision loss (apoplexy)
- Worsening visual field defect
- Clear fluid from the nose during treatment (CSF leak)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.