Makindo Medical Notes

Related Subjects: |Male Infertility |Prolactin |Prolactinoma |Sheehan's syndrome |Acromegaly and Giantism

💊 Surgery is rarely needed — medication (dopamine agonists) usually suffices ✅ with an excellent prognosis.

📖 About

• Most common secreting pituitary tumour 🧠
• Accounts for ~30% of pituitary tumours
• ♀ : ♂ ratio ~10:1 (women >> men)
• Frequently found incidentally at post-mortem, often clinically silent
• Usually treatable with medical therapy

🩺 Clinical Features

• Often asymptomatic → discovered late or incidentally
• 👩‍🍼 Galactorrhoea (~90% women, rare in men)
• ⚠️ Amenorrhoea, oligomenorrhoea, infertility, ↓ libido
• 🦴 Long-term → low bone mineral density (due to hypogonadism)
• ♂ Hypogonadism (low testosterone from PRL suppression)
• ⛔ Pituitary mass effects: headache, visual field loss

🔍 Investigations

• 🧪 Fasting serum prolactin: - Normal: < 20 ng/mL (625 mU/L) in women; < 15 ng/mL (375 mU/L) in men - Raised PRL → exclude macroprolactin
• ⬇️ Testosterone often low (men)
• 🧠 Pituitary MRI + gadolinium → microadenoma / macroadenoma
• 👁️ Visual field testing if suprasellar extension
• 🧪 Check pituitary panel (FSH, LH, TSH, cortisol, etc.)
• ❤️ Echocardiogram before starting cabergoline (rare valvopathy risk)

🧾 Differential Diagnosis

• Physiological ↑ PRL: pregnancy, lactation 🤰
• Drug-induced ↑ PRL (antipsychotics, antidepressants, metoclopramide)
• Non-secreting adenoma pressing on pituitary stalk (“stalk effect”)

💊 Management

• ✨ Medical (first-line) → only pituitary tumour usually managed medically
• 🚀 Dopamine agonists (cabergoline 0.5–1 mg/week in 2 doses; bromocriptine less used) → shrink tumour + normalise PRL
• 📉 Recurrence risk ↑ if residual tumour visible on MRI when treatment is stopped
• ❤️ Valvopathy risk with cabergoline is very low at standard doses (<2 mg/week)
• 🔪 Surgery (transsphenoidal hypophysectomy) → rarely indicated (failure, intolerance, vision compromise)
• ☢️ Radiotherapy reserved for refractory or large tumours
• ⚠️ Malignant prolactinomas = extremely rare