Prolactinoma
| Classification according to ICD-10 | |
|---|---|
| D35 | Benign neoplasm of other and unspecified endocrine glands |
| D35.2 | Pituitary gland |
| ICD-10 online (WHO version 2019) | |
The prolactinoma is a benign tumor ( adenoma ) of the anterior pituitary gland (adenohypophysis) that produces prolactin . This leads to an excess of prolactin in the blood called hyperprolactinemia .
Epidemiology
The prolactionoma is the most common pituitary tumor with a gender ratio of ♀> ♂ (about 5: 1)
Symptoms
The symptoms express themselves
- in women by milky discharge from the breast called galactorrhea , menstrual disorders with oligo- or amenorrhea , lack of ovulation ( anovulation ) and sterility , long-term osteoporosis and atrophy of the vaginal epithelium due to lack of estrogen or an endogenous psychosyndrome with depression or anxiety
- in men by impotence , libido disorders and rarely gynecomastia with galactorrhea. In men, the increased prolactin level with the testosterone deficiency can also lead to a reduction in the quality of the sperm (number, mobility and morphology) and even sterility.
If the tumor increases in size, mechanical action can lead to headaches, visual field defects and partial to complete pituitary insufficiency .
Diagnosis
The basal prolactin level is determined. Values> 20 µg / l (♂) and> 25 µg / l (♀) are suspicious, from values> 200 µg / l a prolactinoma can be assumed. A prolactin stimulation test can be carried out for differential diagnosis. To distinguish between macroprolactinoma (> 1 cm) and microprolactinoma (<1 cm), magnetic resonance imaging (MRI) of the head is performed in most cases.
therapy
Prolactinomas can usually be treated with certain drugs called dopamine agonists ( bromocriptine , cabergoline or quinagolide ). An operation is only necessary in the event of resistance to therapy, intolerance of the therapy, prolactinomas that cannot be influenced by drugs quickly enough, with impaired visual field, the desire to have children and acute signs of intracranial pressure such as severe headache or loss of consciousness due to tumor hemorrhage after starting treatment of a prolactinoma with dopamine agonists. In these cases, irradiation can also be carried out if inoperable. In rare cases, prolactinomas can also occur in children and are often successfully treated by tumor resection.
Individual evidence
- ^ Y. Liu, Y. Yao, B. Xing, W. Lian, K. Deng, M. Feng, R. Wang: Prolactinomas in children under 14. Clinical presentation and long-term follow-up. In: Childs Nerv Syst. 2015 Mar 15, PMID 25771923 .
