What symptoms do prolactinomas cause?
High levels of prolactin in the blood can cause various symptoms. The symptoms differ slightly between men, women and children.
Women may have:
- Irregular periods or no periods.
- Reduced fertility.
- Reduced sex drive.
- Milk leaking from the breasts (known as galactorrhoea). The milk may leak out by itself, or may only show when the breast is squeezed. (Note: leakage of milk from the breasts is normal towards the end of pregnancy, with recent childbirth, if breast-feeding and for some time after finishing breast-feeding.)
- Increased growth of hair on the face or body.
Men may have:
- Reduced fertility.
- Difficulty having an erection (erectile dysfunction).
- Reduced sex drive (libido).
- Breast enlargement (called gynaecomastia).
- Very rarely, leakage of milk from the breasts.
Children and teenagers may have:
- Reduced growth.
- Delayed puberty.
Prolactinomas which are large may press on the brain or nearby nerves (the nearest nerves are the optic nerves which go to the eye). Some prolactinomas can get bigger during pregnancy. Larger prolactinomas may cause symptoms such as:
- Eye symptoms - you may get reduced vision or double vision. The early changes can easily go unnoticed, because they affect the peripheral vision - that is, the edges of your vision to the extreme left and right. This means that you may see less of what is around you, but can still see well if you focus on something directly.
Rarely, the prolactinoma may press on the rest of the pituitary gland, stopping it from producing other hormones. This can cause symptoms such as tiredness, fainting, low blood pressure, low blood sugar or collapse. Also (rarely) there may be a leakage of the fluid that surrounds the brain and pituitary gland, felt as watery fluid leaking through the nose. These symptoms need urgent treatment.
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- Molitch ME; Endotext. Prolactinoma Management. April 2015.
- Molitch ME; Diagnosis and Treatment of Pituitary Adenomas: A Review. JAMA. 2017 Feb 7 317(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 6 11(1):135.
- Position statement on the use of dopamine agonists in endocrine disorders; Society for Endocrinology (Feb 2009 - reviewed Nov 2011)