Prolactinoma through the female life cycle
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REVIEW
Prolactinoma through the female life cycle Deirdre Cocks Eschler1 Pedram Javanmard2 Katherine Cox2 Eliza B. Geer3 ●
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Received: 24 July 2017 / Accepted: 22 September 2017 © Springer Science+Business Media, LLC 2017
Abstract Prolactinomas are the most common secretory pituitary adenoma. They typically occur in women in the 3rd–6th decade of life and rarely in the pediatric population or after menopause. Most women present with irregular menses and/or infertility. Dopamine (DA) agonists, used in their treatment, are safe during pregnancy, but in most cases are discontinued at conception with close monitoring for signs or symptoms of tumor growth. Breastfeeding is safe postpartum, provided there was no significant growth during pregnancy. Some women will experience normalization of prolactin levels postpartum. Menopause may also decrease prolactin levels and even those with macroprolactinomas may consider discontinuing their DA agonist with close follow-up. Prolactinomas may be associated with decreased quality of life scores in women, and play a role in bone health and cardiovascular risk factors. This review discusses the current literature and clinical understanding of prolactinomas throughout the entirety of the female life cycle.
* Eliza B. Geer [email protected] 1
Department of Medicine, Division of Endocrinology and Metabolism, SUNY Stony Brook School of Medicine, 26 Research Way, East Setauket, New York, NY 11733, USA
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Department of Medicine, Division of Endocrine, Diabetes, and Bone Disease, Icahn School of Medicine at The Mount Sinai Hospital, 1 Gustave L Levy Place box 1055, New York, NY 10029, USA
3
Multidisciplinary Pituitary and Skull Base Tumor Center, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 419, New York, NY 10065, USA
Keywords Prolactinoma Pregnancy Menopause Hyperprolactinemia ●
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Introduction/Epidemiology Of all intracranial tumors, 10–15% are pituitary tumors with a prevalence as high as 27% at autopsy [1, 2]. Prolactinomas comprise the majority of all pituitary adenomas at approximately 40–66% and are the most common cause of elevated prolactin levels [3–5]. It is estimated that prolactinomas affect 100 per million of the population [6]. Within the general population, prolactinomas are most frequently found in women between 20 and 50 years old, with the incidence being four times greater in women than men [2, 4]. After age 50, prolactinomas occur in men and women with the same frequency [5] or in some reports with a higher frequently in men [7]. Women present earlier than men, perhaps due to symptoms including galactorrhea and irregular menses, whereas men have a higher frequency of macroprolactinomas (diameter >10 mm), either due to the lack or early symptoms, or due to more aggressive tumors [8, 9]. This paper describes changes in prolactin (PRL) and presentation, natural history, comorbidities, and treatment outcomes of prolactinomas through the female life cycle.
Prenatal pituitary development The pituitary gland begins development from two separate
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