By contrast, men frequently exhibit fertility issues and hormonal disruptions, such as a loss of libido, but are also more likely to show signs of the tumor compressing their brain tissue, such as headaches, vision changes, and other symptoms outlined below.
[2] The symptoms due to a prolactinoma are broadly divided into those that are caused by increased prolactin levels or mass effect.
[6] Prolactinoma is most frequently a sporadic tumor, occurring in people without any concrete risk factors or family members with similar conditions.
[2] Despite their frequent association with genetic syndromes that cause multiple cancers in affected body tissues, the large majority of prolactinomas are monoclonal in origin (originating from a single cell developing a random mutation), even in cases where the tumor begins producing multiple distinct hormones aside from prolactin.
However, it is still recommended that patients with known microprolactinomas should receive an MRI and visual field assessment every 6 to 12 months, to detect unexpected progression and expansion of the tumor before it becomes an emergency.
[2] Among cases of sporadic prolactinoma, in patients with no family history of pituitary tumors, the splicing factor 3B1 gene (SF3B1) has been found as a common causative mutation.
As such, smaller tumors which may produce excess prolactin or other hormones may not cause any vision problems, while still having major symptomatic effects on the body.
[2] Elevated prolactin levels in the patient's serum are indicative of hyperprolactinemia, but are not specific to prolactinoma, meaning that other diseases causing similar symptoms could produce the same test results.
[8][10] Dopamine agonist testing can, however, be used to determine the effectiveness of DAs like bromocriptine as a potential non-surgical treatment option.
In some, however, prolactin levels remain normal, so the doctor may suggest reducing or discontinuing treatment every two years on a trial basis.
Recent studies have shown increased success in remission of prolactin levels after discontinuation, in patients having been treated for at least 2 years prior to cessation of bromocriptine treatment.
However, people with low blood pressure should use caution when starting cabergoline treatment, as the long half-life of the drug (4–7 days) may inadvertently affect their ability to keep their blood pressure within normal limits, creating intense discomfort, dizziness, and even fainting upon standing and walking until the single first dose clears from their system.
[citation needed] Other dopamine agonists that have been used less commonly to suppress prolactin include dihydroergocryptine, ergoloid, lisuride, metergoline, pergolide, quinagolide, and terguride.
Even in patients with large tumors that cannot be completely removed, drug therapy may be able to return serum prolactin to the normal range after surgery.
Although estrogen/testosterone production may be restored after treatment for hyperprolactinemia, even a year or two without estrogen/testosterone can compromise bone strength, and patients should protect themselves from osteoporosis by increasing exercise and calcium intake through diet or supplementation, and by avoiding smoking.
[citation needed] If a woman has one or more small prolactinoma, there is no reason that she cannot conceive and have a normal pregnancy after successful medical therapy.
In women with large tumors, the risk of damage to the pituitary or eye nerves is greater, and some doctors consider it as high as 25%.
[citation needed] A woman with a prolactinoma should discuss her plans to conceive with her physician, so she can be carefully evaluated prior to becoming pregnant.
This evaluation will include a magnetic resonance imaging (MRI) scan to assess the size of the tumor and an eye examination with measurement of visual fields.
As soon as a patient is pregnant, her doctor will usually advise that she stop taking bromocriptine or cabergoline, the common treatments for prolactinoma.
The patient should consult her endocrinologist promptly if she develops symptoms — in particular, headaches, visual changes, nausea, vomiting, excessive thirst or urination, or extreme lethargy.