Endocrine Abstracts

Relevance: Prolactinoma is an adenoma of the pituitary gland with the production and secretion of prolactin (PRL) in varying degrees, almost always benign, but, nevertheless, often clinically significant and causing difficulties in treatment. Often prolactinomas are classified according to size as microadenomas (less than 10 mm in diameter) or macroadenomas (more than 10 mm in diameter). More than 90% of prolactinomas are small, intrasellar tumors that rarely increase in size. Sometimes, these adenomas can be aggressive or locally invasive and cause compression of vital structures. Malignant prolactinomas that are resistant to treatment and are dissiminated into I and out of the CNS are very rare. Approximately 40% of all pituitary adenomas are prolactinomas. The age of patients varies widely and there are publications about prolactinomas in patients between the ages of 2 and 80 years. Prolactinomas are common in women with a peak frequency in fertile age. Although often these tumors attract attention after discontinuation of oral contraceptives, there is no correlation between the use of oral contraceptives and the development of prolactinomas. Most prolactinomas in women are presented by microadenomas. About 90% of premenopausal women have oligo/amenorrhea, up to 80% also observe galactorrhea. Inovulatory infertility may also occur in some cases. Pathogenesis of prolactinomas is unknown, but the process may involve an early genomic mutation leading to a mutation in pituitary stem cells. Various contributing factors can stimulate the proliferation of mutated cells. Family forms of prolactinomas were also described, which indicate the possibility of a genetic component playing role in pathogenesis. Prolactinomas are the most common cause of persistent increase of serum prolactin levels, which is more common in women of reproductive age and may be the cause of infertility. The clinical manifestations of hyperprolactinemia vary widely, the symptoms mainly include reproductive, sexual, metabolic and emotional-personal impairments, and in macropolactinoma, signs and symptoms of a volumetric process in the hypothalamic-pituitary region. The method of choice in the treatment of most patients with prolactin secreting pituitary adenomas is drug therapy. Treatment of hyperprolactinemia in prolactinomas is aimed at achieving the restoration of normal prolactin concentration, restoring ovulatory menstrual cycles, restoring fertility in women and men and in improving impaired sexual function in men, and reduction in tumor size.