What are the complications and outlook for prolactinomas?
What are the possible complications?
The main complication is the risk of 'thinning' of the bones (osteoporosis), which occurs if high prolactin levels are untreated for a long time (over one year). Osteoporosis can be prevented by treating the prolactinoma (as above). Alternatively, replacement oestrogen or testosterone can be taken.
Large prolactinomas may cause complications if they grow and press on the structures nearby: the pituitary gland, the brain and the nerves to the eye. If untreated, the pressure might eventually lead to loss of vision, other hormone problems (which could cause severe illness) or severe headaches.
Rare complications are:
- A leak of fluid from around the brain into the nose, which causes a risk of infection such as meningitis.
- Pituitary apoplexy, which is rare but very serious. There is a bleed inside the tumour, making it suddenly expand. This causes sudden increasing symptoms such as headache and reduced vision, and may cause collapse. It needs urgent treatment and may require surgery.
What is the outlook?
The outlook (prognosis) for most people with a prolactinoma is very good. Most prolactinomas are successfully treated with medication. If this does not work, surgery is usually successful.
Treatment for women can restore periods and fertility (assuming that the fertility problem was due to the prolactinoma). Fertility for men can also improve with treatment.
For some people, the prolactinoma may be cured after about three years of taking medication. So you may be able to come off treatment.
Prolactinomas can come back, even after successful treatment with medication or surgery. You will still need monitoring (such as regular blood tests) to check that the prolactinoma has not come back. If it has, then treatment can be restarted.
Further reading and references
Molitch ME; Endotext. Prolactinoma Management. April 2015.
Molitch ME; Diagnosis and Treatment of Pituitary Adenomas: A Review. JAMA. 2017 Feb 7317(5):516-524. doi: 10.1001/jama.2016.19699.
Brue T, Castinetti F; The risks of overlooking the diagnosis of secreting pituitary adenomas. Orphanet J Rare Dis. 2016 Oct 611(1):135.
Position statement on the use of dopamine agonists in endocrine disorders; Society for Endocrinology (Feb 2009 - reviewed Nov 2011)
I’ve had two blood test indicating high prolactin levels and I display most symptoms of a prolactinoma, I’m not getting an mri for another 3 weeks and I’m feeling rather anxious to understand what’s...lily1993
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