Prolactinoma

D35.2 + (M8271/0)

• Description
• Medicine treatment
• Referral

DESCRIPTION

Prolactinoma is the most common functioning pituitary tumour.

Investigations

Serum prolactin, β-hCG.

Note:

• There are numerous causes of hyperprolactinaemia other than a prolactinoma, so secondary causes must be excluded e.g. pregnancy, medicines, physiological, hypothyroidism, chronic renal failure and tumours.
• In patients with prolactinoma, serum prolactin levels are usually elevated ≥4 times the upper limit of the normal reference range for the laboratory method used. Lesser degree of elevation of serum prolactin may also be found in patients with other pituitary tumours associated with pituitary stalk compression.

MEDICINE TREATMENT

Dopamine agonist therapy is the treatment of choice.

• Bromocriptine, oral, 1.25 mg at bedtime with a snack.
  • Initial maintenance dose: increase dose to 2.5 mg 12 hourly with food and check prolactin 4 weeks later.
  • Higher doses may be needed.
  • GIT side effects are minimised by giving doses with food.
  • If total dose of 10 mg does not normalise prolactin, refer.

REFERRAL

• All tumours, once causes of secondary hyperprolactinaemia have been sought and excluded.
• Intolerance to bromocriptine.
• Unexplained hyperprolactinemia.

Urgent

• Any visual disturbances, especially those suggesting compression of optic chiasm.
• Pituitary apoplexy.