CLINACASE

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ID: 210
Category: Endocrinology
CreatedBy: 1
UpdatedBy: 1
createdon: 28 Feb 2023
updatedon: 06 Apr 2023

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Author: Khoa Tran
Published Feb 28, 2023
Updated Apr 06, 2023

Table of contents

Prolactinoma

Etymology and Pronunciation

Prolactinoma (proh-lak-tuh-NOH-muh)
prolactin - hormone produced by the pituitary gland
oma - Greek for "swelling" or "tumor"

prolactin (proh-LAK-tin)
pro - Latin for "before"
lac - Latin for "milk"

History of Prolactinoma

Prolactinoma is a type of pituitary tumor that leads to overproduction of the hormone prolactin. 

In 1910, a German physician named Harvey Cushing described the symptoms of acromegaly, a condition caused by excessive production of growth hormone by the pituitary gland. Cushing also noted that patients with acromegaly often had enlarged pituitary glands. During this time, they did could not measure serum (blood) prolactin levels, so they instead removed and weighed the pituitary tumors in order to come to their findings.

In the 1930s, researchers began to identify the role of prolactin in lactation and breast development. It was also noted that patients with pituitary tumors often had high levels of prolactin in their blood. In order to prove the connection between prolactin and lactation, researchers were able to extract a hormone from the anterior pituitary gland of cows that stimulated milk production in rats. 

During that time, in the 1930s, one of the earliest methods for extracting prolactin involved using alcohol to precipitate the hormone from the pituitary gland tissue. Researchers would grind up the pituitary glands and then add alcohol to the tissue to extract the hormone. The alcohol would then be evaporated to leave behind a purified prolactin extract. 

Today, more advanced methods were developed for purifying prolactin, including gel filtration chromatography and high-pressure liquid chromatography (HPLC). These techniques allowed for more accurate and precise purification of prolactin and other hormones from animal tissues.

During the mid-1900, advances in imaging technology, such as the development of the CT scan and MRI, allowed for more accurate diagnosis of pituitary tumors, including prolactinomas.

In the 1980s, the discovery of dopamine agonist medications, which reduce prolactin levels by inhibiting its production, revolutionized the treatment of prolactinoma. These medications, such as bromocriptine and cabergoline, are still widely used today to treat prolactinoma.

Modern Understanding of Prolactinoma

Prolactinoma is a type of benign tumor that develops on the pituitary gland, which is a small gland located at the base of the brain that is responsible for making prolactin. Prolactin is a hormone that is primarily known for its role in lactation or milk production in female mammals. This tumor produces too much of the hormone prolactin, which can lead to a variety of health problems.

In men, it helps to regulate the immune system, metabolism, and reproductive system. When a prolactinoma develops, it can cause high levels of prolactin in the blood, leading to a range of symptoms.

Symptoms of prolactinoma may include irregular or absent periods in women, decreased sex drive in both men and women, infertility, breast milk production in women who are not pregnant or breastfeeding, and headaches. The tumor can also cause vision problems if it grows large enough to press on the optic nerve.

Causes of Prolactinoma

The exact cause of prolactinoma is not fully understood, but there are several factors that can increase the risk of developing this condition.

- Genetics: Prolactinoma may have a genetic component, meaning that it can be passed down through families. Individuals with a family history of pituitary tumors or multiple endocrine neoplasia type 1 (MEN1) are at an increased risk of developing prolactinoma.
- Hormonal imbalances: An imbalance in the hormones that regulate the production of prolactin can lead to prolactinoma. For example, the hormone estrogen, which is present in higher levels in women than men, can increase the production of prolactin.
- Medications: Certain medications, such as antidepressants, antipsychotics, and high blood pressure medications, can increase the production of prolactin and lead to prolactinoma.
- Trauma: Trauma to the head or brain, such as a concussion or traumatic brain injury, can damage the pituitary gland and lead to the development of prolactinoma.
- Pregnancy and breastfeeding: During pregnancy and breastfeeding, the body produces higher levels of prolactin to stimulate milk production. In some cases, this increased production can lead to the development of prolactinoma.
- Unknown causes: In many cases, the exact cause of prolactinoma is unknown. It may develop spontaneously without any clear underlying cause.

Treatments for Prolactinoma

Prolactinomas are typically treated with medication, such as dopamine agonists, which help to lower prolactin levels in the blood. In some cases, surgery may be necessary to remove the tumor. With proper treatment, most people with prolactinoma can manage their symptoms effectively and lead normal lives.

It's important to note that while prolactinomas are usually benign, meaning they are not cancerous, they can still cause significant health problems if left untreated. Anyone who is experiencing symptoms of prolactinoma should talk to their doctor as soon as possible to get an accurate diagnosis and begin treatment.

Symptoms

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826
Decreased sex drive in men and women
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827
Reduced muscle mass and bone density
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Headaches
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829
Vision changes or loss, particularly in the peripheral vision
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830
Mood changes, such as depression or anxiety
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831
Difficulty getting pregnant
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832
Milky discharge from the breasts when not pregnant
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833
Heavy or irregular periods
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834
Painful intercourse (sex)
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835
Erectile dysfunction
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836
Fatigue
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837
Muscle Weakness
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838
Infertility

Confirmation Tests

- Blood test
- MRI
- Vision tests

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