History and exam
Key diagnostic factors
common
amenorrhea or oligomenorrhea
Common presenting feature in women with prolactinoma.
infertility
High prolactin inhibits ovulation in women.
galactorrhea
Sometimes identified only during physical examination.
loss of sexual desire (libido)
Hyperprolactinemia causes secondary hypogonadism.
A particular clinical feature in men with prolactinoma.
erectile dysfunction
Common presentation in men with prolactinoma.
visual deterioration (e.g., temporal hemianopia)
Bilateral hemianopia occurs in patients with macroadenomas with suprasellar extension.
Other diagnostic factors
common
osteoporosis
A consequence of low testosterone/estradiol level.
uncommon
ophthalmoplegia
Related to cranial nerve palsy.
headaches
Related to pituitary apoplexy (a clinical syndrome resulting from acute hemorrhagic or ischemic infarction of a pituitary adenoma).
Risk factors
strong
female sex, 20 to 50 years of age
Prolactin-secreting adenomas are more frequent in premenopausal women.
There is a peak incidence between 20 to 50 years of age, and an estimated ratio of frequency between women and men of 10:1.[1]
weak
genetic predisposition (e.g., presence of mutation resulting in multiple endocrine neoplasia-1 [MEN-1], familial isolated pituitary adenoma [FIPA])
Ninety-nine percent of prolactinomas are sporadic. However, pituitary adenomas, including prolactinomas, can also occur as part of the MEN-1 due to germline mutations in the gene encoding menin (MEN-1). Prolactinomas also occur in the setting of FIPA due to inactivating germline mutations of the gene encoding aryl hydrocarbon receptor-interacting protein, located close to that of MEN-1, on chromosome 11q13.[8][9]
estrogen therapy
Medication-induced hyperprolactinemia is associated with estrogen therapy, but use of oral contraceptives or postmenopausal hormone replacement therapy does not increase susceptibility to prolactinoma development.[10]
male sex, 30 to 60 years of age
Although prolactinomas are rare in men, if they do present in this age range it is usually with macroadenomas or they present incidentally.
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