A prolactinoma of the pituitary gland: symptoms, treatment in women and men
Prolactinoma refer to benign neoplasms of the anterior lobe of the pituitary gland, common in middle-aged persons, and women are affected 10 times more than men. After 50 years, the tumor is recorded equally often in both sexes. Neoplasia produces the hormone prolactin, necessary for proper milk production during breastfeeding, but higher concentrations cause a variety of endocrine-metabolic disorders, infertility, visual disturbances.
The pituitary gland is a very active endocrine glands, which regulates other endocrine organs, secreting a biologically active substance. According to some, a slight hyperplasia of its tissue is found in about a quarter of the world’s population that does not manifest symptoms and usually goes unnoticed. About 40% of clinically significant hyperplasia (adenomas) are in prolactinoma.
Prolactin not only regulates the flow of milk, but also the reproductive system overall, including reproductive capacity. Excess hormone inhibits the synthesis of female sex hormones estrogens. If this phenomena is considered normal when breast-feeding, when the chances of getting pregnant is minimal, then relaksiruyushaya women ovarian suppression leads to menstrual disorders and infertility. In men, a prolactinoma causes a decrease in testosterone concentrations, which also affect sexual activity.
Causes and types of tumors
Causes of prolactinomas are still not clear. Some patients traced unfavorable heredity in relation to the tumor, a prolactinoma develops in other part of multiple endocrine neoplasia of the first type, which has a genetic basis. The likely role of spontaneous mutations in genes, which continues scientists-geneticists.
Depending on how the tumor is located in the Sella and what are its dimensions, it is customary to distinguish two varieties of prolactinoma:
- Intracellularly microprolactinoma.
- Ekstrazellliarna macroprolactinoma.
The first option does not exceed 10 mm, therefore, the tumor located within the Sella (intrasellar). Macroadenoma greater than 1 cm in diameter, does not fit into pituitary fossa and outside its borders (ekstrazellliarno). Both species are characterized by increased synthesis of the hormone prolactin. Microadenomas typically have a diameter of 2-3 mm and are more common of big formations, macroadenoma more than 1 cm often diagnosed in men.
It is believed that tumor size is not associated with the time in which she grew up, and identifies the importance of proliferative potential of its cells. In other words, the sooner share of the adenoma cells, the large size it attains, in this large tumor may be formed for a shorter time period than microadenoma a few millimeters. Cells makroadenom men have a strong ability to divide, in contrast to those in women.
Manifestations of prolactinomas of the pituitary gland
Pituitary adenomas cause a variety of changes in the emotional background, endocrine disorders, and symptoms of local compression of brain structures. Violations of the psychological plan and local manifestations of the tumor are similar in both sexes, and as a prolactinoma secretes hormones that affect the metabolism of sex hormones, changes in the genital area are different in men and women.
Large prolactinomas able to compress the optic nerves and chiasm due to the proximity of the latter, and signs such macroprolactinoma can be:
In addition to ophthalmologic disorders, prolactinomas large amounts cause headache and changes in emotional background in the form of depression, apathy, irritability and frequent mood changes, feelings of unexplained anxiety. Possible serious distress to the point of autism and impaired social adaptation. A number of patients noted a decrease in memory and ability to concentrate, which inevitably affects professional activity.
Other symptoms in women differ from those of men that is connected with direct action of prolactin on the sex glands. In connection with the inhibition of synthesis of estrogens under the influence of large doses of prolactin decreases sexual function and symptoms of the tumor are:
- Menstrual cycle;
The disadvantage of the female hormones estrogen dangerous lack of ovulation and disruption of the normal menstrual cycle. The woman complains of irregular, scanty, and rare menstruation or complete absence of, the inability to get pregnant.
Infertility is the main complaint of women with microprolactinomas to the doctor. The gynecologist may be the first among the experts to suspect a tumor for the presence of characteristic signs from the mammary glands, hypoplastic changes in the uterus and infertility. In this case, the patient will be sent to the endocrinologist, and she has a set of surveys.
Stimulation of the epithelium of the mammary glands is accompanied by the overproduction of milk, which is highlighted by drops in pressure or flows freely, when it very much. This lactation occurs spontaneously and is not caused by previous pregnancy and childbirth. In some cases of galactorrhea combined with mastopathy.
Women suffering from prolactinomas, more prone to osteoporosis because under the influence of prolactin from the bones takes calcium. It is fraught with excessive fragility of bone with high probability of fractures. Due to lower estrogen is fluid retention, and weight gain.
In men excess prolactin leads to a decrease of testosterone synthesis, the symptoms of a tumor will be:
Mammary glands in prolactinoma increase in men and, like women, able to milk. In addition, atrophy of the testes, osteoporosis, decreases the number of hairs on the face.
A kind of manifestation of prolactinomas may become hemorrhagic infarction of the pituitary gland, accompanied by sudden pain in the head, nausea, vomiting, possible disturbance of consciousness and meningeal signs.
Endocrine-metabolic disorder associated with compression of the other departments of the pituitary gland neoplasia increasing and they occur weight gain for both women and men. Characteristic fluctuations in glucose levels because of insulin resistance, abnormalities in lipid metabolism.
If you suspect prolactinoma need it is worth remembering that the increase in the concentration lactotropes hormone can be worn physiological in nature. For example, prolactin increases during the meal rich in proteins, reducing glucose levels (hypoglycemia) during sleep and emotional issues in surgical operations and intensive physical loads. In women, the physiological increase in the hormone occurs in the second phase of the menstrual cycle, during pregnancy, during childbirth and breastfeeding, the baby’s chest.
In addition to these factors, on the concentration of prolactin is influenced by taking certain groups of drugs:
- Antipsychotics and antidepressants used in psychiatry;
- Drugs used to treat ulcers and gastritis (ranitidine, famotidine);
- Hormonal contraceptives with high dose estrogen component.
Described the circumstances should be taken into consideration before taking a blood test for prolactin to tumor was not diagnosed wrongly.
Video: causes of hyperprolactinemia is a prolactinoma, and other
How to detect and treat prolactinoma?
Consequences of the tumor may become severe metabolic disorders, deficiency of pituitary hormones, infertility, therefore, any case of suspicious tumors, requires the expansion of diagnostic search. In order to confirm or rule out tumors of the pituitary patient is prescribed:
The latest study to date is almost never used because of the low reliability of the results. The determination of prolactin concentration in the blood is carried out not less than three times the norm may be exceeded because of renal failure, hypothyroidism, lesions of the hypothalamus.
Patients with impaired obligatory consultation of the ophthalmologist, the women are sent to the obstetrician-gynecologist, suspected osteoporosis is the reason for densitometry – definition of bone substance.
Prolactinoma pituitary, like many benign tumors, try to treat it conservatively, and only the ineffectiveness of this approach, the doctors resort to more radical methods – radiation, surgical removal.
Drug treatment is aimed primarily, but the normalization of hormonal levels by reducing the release of prolactin is increased by the anterior lobe of the pituitary gland. Usually the effect occurs within a few weeks from the start of therapy, and the concentration of the hormone comes back to normal. Together with the metabolic system, reduced amounts of prolactinomas, as evidenced by dynamic CT scan.
In parallel with normalization of hormone levels in women restores menstrual cycle, and in men increases the amount of testosterone that improves sexual activity and sex life in General. Women on this period can get pregnant, not looking for a long period of infertility caused by the tumor. This fact should be considered that pregnancy was not an unwanted surprise.
When microadenoma that produce prolactin, the primary goal of treatment is the restoration of hormonal levels, as these tumors do not usually disrupt the function of the optic and other cranial nerves. In the case of macroprolactinoma main goal is to reduce the size of tumors, and treatment of hypogonadism and infertility.
Treatment regimen, the drugs, their doses determined by the doctor-endocrinologist individually, do not self medicate although in Internet you can find the names of the tools and methods of their use. Hormonal balance is very finely tuned mechanism, and it should only be a specialist.
The dosage of the medication selected based on the level of prolactin, which is controlled once a month at least reduce the hormone, and when it reaches normal values analysis is enough to be done every 3-6 months. The optimal dose is that at which normal level of hormones decreases the swelling and regain sexual function.
For medical treatment of prolactinoma are applied bromocriptine, cabergoline, dostinex, levodopa, peritol and other drugs capable of stimulating dopamine receptors. Bromocriptine, cabergoline and dostinex is the most popular. When taking bromocriptine hormone levels to normal within 3-4 weeks more than 80% of patients, cabergoline close to it in structure but has a more selective effect, causing the frequency of side effects is much lower. Dostinex is different fewer side effects and prolonged action, so it suffices to 1-2 times a week.
During treatment reduced the size of the tumor, so many patients almost immediately notice improved vision. For large prolactinomas medical therapy is carried out under continuous imaging control.
A major problem of drug therapy of prolactinoma is the development of tumor resistance to drugs. In this case, it is possible to increase dose to the maximum, change of drug or surgical or radiation treatment. It should be noted that prolonged intake of large doses of agonists of dopamine receptors can lead to a defeat of the heart valves, so patients are shown ultrasonic inspection.
In the absence of effect of conservative treatment, continued growth of the tumor and progressive visual disorders, however, there is a small number of patients, radiation therapy or removal of the tumor surgically. Radiation therapy may be the treatment of choice if surgery for a variety of reasons is contraindicated or the patient himself strongly against such treatment.
Surgical tumor removal is transsphenoidal access, that is, through small incisions in the paranasal sinuses. The use of endoscopic techniques minimizes surgical trauma and associated risks. The autopsy the cavity of the skull (craniotomy) is used only rarely, when no other way to excise a tumor there.
The indications for surgical treatment are:
- Severe visual disturbances, hemorrhage into the tumor;
- Ineffectiveness of drug treatment, intolerance to drugs;
- The growth of prolactinomas in pregnant women.
Radiation therapy and radiosurgery
Irradiation is an additional method that is accessed with the ineffectiveness of others. It does not give immediate effect to reduce the swelling may take several years, so may not be indicated for women who wish in the near future to realize the reproductive function. Furthermore, with this treatment there is a risk of damage to other hormoneproducing sections of the pituitary gland, and it is dangerous to the development of pituitary insufficiency, then the patient will be forced to take the substitution to a variety of synthetic hormones (L-thyroxine, glucocorticoids, estrogens or testosterone).
The traditional radiation therapy comes a new, highly efficient and more secure way radiosurgery. The impact of an intense beam of radiation strictly to tumor tissue allows to avoid radiation damage to other structures of the brain. Radiosurgery is indicated for prolactinomas size 4-22 mm, and the distance to the optic nerves should not be less than 2 mm. Because radiolucency tumor reduced gradually, this period, patients need drug therapy.
The prognosis of prolactinomas depends on the size of the tumor and its sensitivity to therapy. When microadenoma the likelihood of recurrence after removal of the tumor reaches 50%, when macroprolactinoma – 70-90%. Drug treatment gives more lasting effect, but it should be long-term and under permanent control of the tumor size. CT scan and consultation ophthalmologist are shown once a year, and the prolactin level is determined every 6 months.