What are the symptoms of prolactinoma?
The most common symptoms of hyperprolactinemia in premenopausal women are amenorrhea and infertility. Galactorrhea occurs in about 80 percent of such women, and some women with prolactinomas have infrequent menstrual flow (oligomenorrhea) or regular menses. Hyperprolactinemia is often detected after discontinuation of the use of an oral contraceptive, but there is no apparent relation between the use of oral contraceptives and the formation of prolactinomas.
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The majority of prolactinomas in women are small at the time of diagnosis, and headaches and neurologic deficits are rare. In contrast, prolactinomas in men typically tend to be large at the time of diagnosis and may cause cranial-nerve dysfunction, visual loss, and hypopituitarism. In men, hyperprolactinemia leads to impotence, infertility, and decreased libido, but these are rarely the initial symptoms; galactorrhea and gynecomastia are uncommon. In both sexes, long-standing hyperprolactinemia leads to low bone density in the spine. After prolactin has returned to the normal range, bone density will increase but does not reach normal values.
In women, a high blood level of prolactin often cause infertility and changes in menstruation. In some women, periods may disappear altogether. In others, periods may become irregular or menstrual flow may change. Women who are not pregnant or nursing may begin producing breast milk. Some women may experience a loss of libido (interest in sex). Intercourse may become painful because of vaginal dryness.
In men, the most common symptoms of prolactinoma are impotence, decreased libido, erectile dysfunction, and infertility. Because men have no reliable indicator such as menstruation to signal a problem, many men delay going to the doctor until they have headaches or eye problems caused by the enlarged pituitary pressing against nearby eye nerves. They may not recognize a gradual loss of sexual function or libido. Only after treatment do some men realize they had a problem with sexual function. |