Prolactinoma

Exam Cram

• Classification: macro and microprolactinomas

• Presentation

  • Macro-adenoma: optic disc compression- bitemporal hemianopia, prolactin > 5-10,000

  • Micro-adenoma: asymptmoatic raised prolactin

• Management

  • 1.  Dopamine agonists (micro & macroadenomas)- cabergoline or bromocriptine (80% success rate)

    2. Surgery if macroadenomas not responding to dopamine agonists

Types

Macro-prolactinomas

• Prolactin > 5000

• 80% Respond to dopamine agonists

Micro-prolactinomas

• Dopamine agonists improve symptoms and surgery outcomes, however many eventually require surgery

• Prolactin < 5000

• Presentation: nil visual defects

• MRI: < 1cm

Non functioning Pituitary Adenoma

• Presentation: bitemporal hemianopia, prolactin 1-5000, hypo-pituitaryism: adrenal insufficiency

• Diagnosis: MRI pituitary

Page written in 2024.