Prolactinoma of the pituitary gland in women, with pregnancy and men

The hormone-active tumor of the anterior lobe of the pituitary gland is prolactinoma. Consider the causes of its appearance, risk factors, symptoms, methods of diagnosis and treatment.

Prolactinoma is a neoplasm, which is formed on the endocrine gland - the pituitary gland. Located in the depth of the brain and refers to benign pathologies.

According to the International Classification of Diseases of the ICD 10, it is included in the Neoplasms category (C00-D48):

D10-D36 Benign neoplasm.

• D35 Benign neoplasm of other and unspecified endocrine glands.
  • D35.2 Benign neoplasm of pituitary gland.

This name of the pituitary lesion is associated with one of its symptoms - the production of an increased amount of the prolactin hormone. Normally it is produced only in women in the last months of pregnancy and continues to be secreted during breastfeeding.

Together with follicle-stimulating and luteinizing hormones, prolactin acts on sexual functions. In women, they provide a regular menstrual cycle and the synthesis of estrogens. And in men - the activity of spermatozoa and the production of testosterone. With an excess of hormones secreted by the tumor, women are suppressed estrogenogenesis, which leads to anovulation and infertility. In men, because of this, sexual desire is reduced, erectile dysfunction and gynecomastia occur.

[1], [2], [3]

Epidemiology

Prolactinomas refer to benign adenomas of the pituitary gland. Statistics indicate that the frequency of their appearance is about 30%. This lesion rarely takes a malignant form - in 2% of cases. Such a degeneration is most often diagnosed in women of childbearing age group. The size of the tumor in women is about 2-3 mm, while in men the adenoma is more than 1 cm in diameter.

[4], [5], [6], [7], [8]

Causes of the prolactinomas

Modern endocrinology and genetics are still continuing research to determine the cause of prolactinoma. Very often the disease is detected against a background of genetic disorders. For example, multiple endocrine neoplasia type I (hereditary pathology) is characterized by increased production of pituitary hormones, parathyroid and pancreatic glands.

Many scientists are inclined to believe that the damage to the pituitary gland and the increased production of prolactin can be due to such factors:

Diseases:

• Infections (encephalitis, meningitis).
• Infiltrative and granulomatous processes.
• Injuries (neurosurgery, irradiation, rupture of the brain stem).
• Metabolic disorders.
• Tumors (germinoma, meningioma).
• Cirrhosis of the liver.
• Chronic renal failure.
• Polycystic ovary.
• Chest injuries and breast stimulation.
• Primary hypothermia.
• Ectopic secretion of hormones.

Medications:

• Antidepressants.
• Blockers of H2 recipes.
• Opiates and cocaine.
• Dopamine blockers.
• Calcium channel blockers.
• Estrogens.
• Adrenergic inhibitors.

When determining the cause of the disease, special attention is paid to the medical history. This takes into account the fact that taking oral contraceptives does not affect the risk of formation or growth of prolactin.

Microadenoma and prolactinoma

The pituitary gland is a cerebral appendage located on the lower surface of the brain. It is the central organ of the endocrine system and produces hormones that are responsible for growth, metabolism and reproductive system. Microadenoma and prolactinoma are tumor lesions of the pituitary gland. Let's consider each of these pathologies in more detail:

1. Microadenoma is a neoplasm, usually benign. It provokes uncontrolled growth of glandular cells due to various disorders and anomalies. The tumor volume is about 10 mm.

Causes:

• Trauma of the skull and brain.
• Genetic determinants.
• Incomplete blood supply to the pituitary gland.
• Intoxication of the body.
• Neuroinfections with the involvement of structures, membranes of the brain and spinal cord into the pathological process.

In addition to the above factors, the disease can occur due to abortion, pregnancy and breastfeeding, hormonal contraception. According to medical statistics, microadenomas are more often diagnosed in women. In men, it is detected during puberty and treated with hormonal drugs.

2. Prolactinoma is a benign lesion of the anterior lobe of the pituitary gland. Most often it is found in middle-aged people. However, women are more prone to this disease than men.

The main symptom is an increased production of prolactin. This hormone regulates the allocation of milk, the reproductive system and reproductive capacity. Excess hormone inhibits the synthesis of female estrogen, which leads to suppression of ovarian function, menstrual cycle and infertility. In men, the disorder manifests itself as a decrease in testosterone concentration and a violation of sexual activity.

[9], [10], [11]

Pituitary adenoma and prolactinoma

According to medical research, pituitary adenoma and prolactinoma are tumor formations of the same origin. The pituitary gland is an endocrine gland located in the lower surface of the brain. Through the hole in the dura mater, it contacts the hypothalamus, forming a close functioning. Both parts of the brain form a hypothalamic-pituitary system, which regulates and controls the work of the endocrine glands.

There are many tumor formations of the pituitary gland, which are called adenomas. Let us consider in more detail the peculiarities of the structure of the organ:

1. The anterior part (adenohypophysis) is about 80% of the gland. It consists of glandular cells of different types, which separate a separate type of hormones. Responsible for the production of such hormones:

• Prolactin - responsible for the menstrual cycle and metabolism, regulates lactation and milk production.
• The thyroid-stimulating hormone is the thyroid gland and the synthesis of its hormones.
• Luteinizing hormone is the synthesis of steroid hormones, ovulation, the formation of the yellow body in the ovaries.
• Adrenocorticotropic - the secretion of steroid hormones by the adrenal glands.
• Follicle-stimulating - responsible for the growth of the endometrium, the maturation of follicles and the formation of steroid hormones.
• Growth hormone is a growth hormone, responsible for the breakdown of glucose and fats, activates the synthesis of protein.

2. Posterior part (neurohypophysis) - produces and accumulates hormones, consists of nerve cells, fibers and neurosecretory bodies. Responsible for the production of such hormones:

• Vasopressin - affects the brain and blood vessels, regulates the work of the kidneys and the amount of water in the body.
• Oxytocin - stimulates uterine contractions, excretion of breast milk.

Pituitary adenoma is a benign tumor from the glandular tissue that forms only in the anterior part of the organ. In this prolactinoma is a hormonal-active formation with extremely slow growth.

Risk factors

Hormonal-active neoplasm in the pituitary gland occurs for a variety of reasons, a number of which have not yet been established. Allocate such risk factors in which the level of prolactin rises and the formation of prolactinoma is possible:

• Incorrect functioning of the thyroid gland.
• Chest injuries.
• Craniocerebral injury.
• Pregnancy and lactation.
• Renal failure.
• Dysfunction of the hypothalamus.
• Hypothyroidism.
• Hypofunction of the liver.
• Increased physical activity.
• Neuroinfections.
• Long-term drug therapy.
• Taking medications that affect the production of a hormone.

The tumor promotes increased production of prolactin. This hormone is responsible for the normal lactation process. Prolactinoma refers to the most common formations of the pituitary gland.

[12], [13], [14], [15], [16]

Pathogenesis

The mechanism of prolactinoma development is not fully understood. The pathogenesis of the tumor is associated with two theories:

• Internal defect - a genetic disorder of at least one cell of the pituitary gland provokes the transformation of the organ into a tumor with its further growth.
• Disorder of hormonal regulation of pituitary gland functions - this process is associated with the functioning of the hypothalamic releasing hormones - liberins and statins. With their excessive production, hyperplasia of glandular tissue occurs, which gives rise to the tumor process.

The formation of neoplasms is also associated with the influence of certain hereditary factors.

[17], [18], [19], [20], [21]

Symptoms of the prolactinomas

Hormonal-dependent damage to the pituitary gland often manifests itself with a sharp increase in the level of prolactin and compression of the tumor surrounding brain tissue. Symptoms of prolactinoma directly depends on its size.

If the tumor is not more than 10 mm, then the following symptoms are observed:

• Strong headaches, most often occur in the region of the temples and are of a permanent nature. This symptom is associated with increased intracranial pressure and pressure formation on the surrounding structures of the brain.
• Various visual impairments are associated with the infringement of the optic nerves that pass near the pituitary gland. Patients complain of narrowing the boundaries of the field of vision, reduced color sensitivity, diplopia, strabismus, reduced visual acuity.
• Painful sensations in the face, in the upper part of the cheeks, wings of the nose, upper lip and the outer edge of the eye. The discomfort arises from the squeezing of the branches of the trigeminal nerve by the tumor. At the same time, the functioning of facial muscles is not disturbed.

If the tumor is more than 10 mm, then it is called macroprolactinoma. It can cause blindness, pathological symptoms from the side of the central nervous system and emotional instability. Large formations lead to a disruption in the production of other gland hormones.

First signs

The larger the size of the tumor, the more symptomatic that indicates its presence. The first signs of prolactinoma:

• Headache.
• Increased irritability.
• Anxiety.
• Prolonged depressive state.
• Doubling objects in the eyes.
• Decreased visual acuity.

As the disease progresses, the symptomatology grows. Because of the excessive production of the hormone, the tumor exerts a compression action on adjacent tissues. This manifests itself as a violation of the functions of organs that are located near the pituitary gland.

[22], [23]

Symptoms of prolactinoma in women

The first symptoms of prolactinoma in women are as follows:

• Change the rhythm of the menstrual cycle, until its termination.
• Absence of ovulation and inability to conceive. This is due to a violation of the formation of hormones (follicle-stimulating and luteinizing) responsible for the normal functioning of the reproductive system.
• Prolonged headaches.
• Breast size reduction.
• Isolation of milk-like liquid from the nipples.
• Dryness of the vagina.
• Decreased libido due to changes in estrogen levels.

In addition to the above symptoms, the disease provokes psychoemotional disorders:

• Decreased concentration of attention.
• Chronic fatigue.
• Increased fatigue.
• Nervous excitability.
• Sleep disturbances.
• Depressive state.

If the pituitary lesions are detected in girls, the patients are diagnosed with:

• Underdevelopment of the genitals - a decrease in the size of the uterus, small labia and clitoris.
• In adolescence, the disease manifests itself in the growth of hair in the male type. Appear stiff pigmented hairs on the upper lip, chin, on the chest and around the nipples, on the abdomen and other parts of the body. Because of the high level of prolactin, the adrenal glands producing androgens are actively working.
• Acne and acne are associated with an elevated level of male sex hormones.
• Obesity - a set of excess weight is due to a violation of fat metabolism.
• Multiple caries and frequent fractures - are associated with loss of calcium due to a violation of mineral metabolism. Gradually, bone tissue loses minerals and other beneficial substances, becoming more fragile.

The above signs of the disease can occur both in the complex and isolated.

Symptoms of prolactinoma in men

Hormone-dependent tumors of the pituitary gland in men are diagnosed much less often than in women.

Consider the main symptoms of prolactinoma in men, caused by a decrease in testosterone and spermatogenesis:

• The weakening of sexual desire.
• Decreased potency.
• Violation of an erection.
• Infertility.
• Increased mammary glands.
• Atrophy of testicles.
• Reduces hair growth on the face.
• Muscle weakness.
• Osteoporosis.
• Severe headaches.
• Impaired visual acuity.

In men, macroprolactinomas are often diagnosed, that is, large tumors.

Prolactinoma in children

According to medical statistics, prolactinoma in children is rare. The disease is about 50% of all adenomas of the pituitary gland, which occupy 2% of intracranial tumors. The symptomatology of the pathological condition in children is scarce and is associated with hormonal changes.

Signs of frustration in girls:

• Primary or secondary amenorrhea.
• Change in body weight (obesity).
• Galactorrhea - discharge from the nipples.

In boys, the symptomatology of the disease may be absent. Because of this, the tumor is detected accidentally during CT, MRI of the brain and other studies. In some cases, the only sign of the disorder is delayed puberty.

Long-existing swelling of the anterior lobe of the pituitary gland disrupts the secretion of gonadotropins, which leads to a lack of functions of the sex glands and impaired synthesis of sex hormones. Neuro-phthalmological symptoms also arise: headaches, dizziness, attention disturbances, visual disturbances.

The treatment is aimed at stabilizing the hormonal background in the child's body. For this, dopaminomimetics are used. Such therapy has a quick and lasting effect. Surgical treatment is extremely rare, and usually, with inflammation of the affected organ.

Prolactinoma and pregnancy

Quite often diagnosed pathology in women is prolactinoma. Pregnancy can act as its provoking factor. Special attention is required by patients with adenoma who wish to have a baby. During the year before the planned conception they are prescribed dopaminergic drugs. In order to reduce the risk of unplanned pregnancy during this period, the use of barrier contraception is recommended.

• If the disease is detected early, there is a high risk of miscarriage. Therefore, the entire first trimester of the patient should be under the supervision of a gynecologist and endocrinologist. The patient is prescribed medicinal analogs of natural progesterone (the drug Utrozhestan).
• If the tumor size is no more than 6 mm, it rarely progresses or complicates the course of pregnancy. Lesions of the pituitary gland over 6 mm require careful monitoring. Since they provoke a sharp increase in estrogen, visual impairment and frequent headaches.
• Such a study as magnetic resonance imaging during pregnancy is not recommended, therefore, it is possible to update the size of the tumor only according to the symptomatology. Particular attention is paid to determining the level of prolactin in the blood. Since the indicators of this hormone make it possible to draw conclusions about the state of the female body.

Treatment of a tumor during pregnancy is not carried out. This is due to the fact that the appointment of drugs that normalize the hormonal background adversely affects the future bearing and future lactation. A couple of months after delivery, a control MRT is performed. If there is a growth of the tumor, suppression of milk production is required. According to statistics, the increase in neoplasm occurs in 15-35% of cases.

Prolactinoma and breastfeeding

The effect of pregnancy on the secretion of prolactin in women with hormone-active pituitary adenoma manifests itself in different ways. The symptomatology and future prognosis are completely dependent on the size of the prolactinoma. Breastfeeding with a tumor growth and worsening of the patient's condition is contraindicated. In this case, prescribe drugs that stop the production of milk, and the woman is sent for follow-up and treatment.

If the size of the growth does not increase, then lactation is allowed up to 2-3 months with regular MRI, visual field control and prolactin level. With longer-term feeding, there is a risk that the adenoma will turn into a malignant form.

Stages

Benign lesion of the pituitary gland, like many other diseases, has certain stages. Tumors are divided according to their size and localization within the pituitary fossa:

1. The first stage is intrasellar microprolactinoma. Their size does not exceed 1 cm, they do not go beyond the Turkish saddle pituitary.
2. The second stage is extrasellar macroprolactinomas. They grow more than 1 cm and extend beyond the Turkish saddle of the pituitary gland, squeezing surrounding tissues and organs.

The size of the tumor affects the symptoms of the disease, which are caused by local pathological changes. In addition, the method of treatment depends on the stage of the disorder.

[24], [25], [26], [27]

Forms

Adenoma of the pituitary gland is hormonal inactive and active. The species of the latter depends on the production of hormones by its constituent cells.

The main classification of adenomas of the pituitary:

• Somatotropin-producing - promotes increased production of growth hormone.
• Prolactin-secreting - is characterized by excessive synthesis of prolactin.
• Adenocorticopin producing - secretion of adrenocorticotropic hormone.
• Thyrotropin-producing - produces thyrotropic hormone.
• Folletropin-producing - causes an increase in the level of gonadotropic hormones.

Division of prolactinoma is carried out in this way:

• Functional - occurs during pregnancy and lactation.
• Iatrogenic - provoked by pharmacological drugs.
• Tumor - is associated with the development of microadenomas and macroadenomas of the pituitary gland.

Each type of disease is capable of provoking infertility, menstrual cycle and potency disorders, CNS disorders and other pathological symptoms.

[28], [29], [30]

Complications and consequences

The hormone-active adenoma of the pituitary gland, left without medical assistance, can lead to serious problems. The main consequences and complications of prolactinoma:

• Visual impairment and blindness - arise due to the growth of the tumor and its pressure on the eye nerves.
• Osteoporosis - loss of bone mass is associated with a decrease in the production of testosterone and estrogen.
• Hypopituitarism - due to the growth of the tumor and the increase in the level of prolactin in the body, there is a hormonal imbalance, insufficiency of the adrenal cortex, hypothyroidism.

In addition to the above problems, prolactinoma very often leads to complications of pregnancy. With normal bearing, the woman's pituitary gland increases, which leads to the production of prolactin. But if the conception occurred against the background of its high level, there is a risk of miscarriage, especially in the early stages.

[31], [32]

Diagnostics of the prolactinomas

Suspect a pituitary tumor can be with the help of characteristic clinical symptoms. Diagnosis of prolactinoma consists of:

• Collection of anamnesis and analysis of patient complaints.
• Identification of the symptoms of the disease and evaluation of its severity.
• Laboratory research.
• Instrumental diagnostics.
• Complex of differential procedures.

The most informative diagnostic method is MRI with the introduction of contrast medium. With its help, the localization of the tumor and its size is determined. To detect macro-prolactinoma CT is performed, which provides a good visualization of the structures of the sphenoid bone. Laboratory tests consist of hormonal studies. If the disease is accompanied by visual impairment, then an ophthalmologist is needed.

[33], [34], [35]

Analyzes

Laboratory diagnostics of prolactinoma consists of:

• Determination of the level of pituitary hormones in blood serum.
• Blood test for prolactin.
• Blood tests for other hormones of the pituitary gland. Excess of one or more indicators may indicate adenoma of the pituitary gland.

Particular attention is paid to determining the level of prolactin. The level of the hormone depends on the size of the tumor. On the presence of neoplasm indicates prolactin above 200 mU / l. If there is an insignificant excess of the norm, then a triple delivery of the analysis is made with an interval of 7-10 days. This allows you to exclude fluctuations in the hormone due to stress and psycho-emotional stress.

[36], [37], [38], [39], [40], [41]

The level of prolactin in prolactinoma

The hormone that causes the formation of milk in the postpartum period is prolactin (produced by the pituitary cells). The level of prolactin in prolactinoma depends on many factors. Its indicators regulate reproductive and sexual functions in the human body. And their violation leads to the development of various pathological symptoms.

The first prolactin is formed in the child's body immediately after birth. In the first weeks of life, his indices are high - about 2000 mU / l. At the expressed increase of a hormone, at children mammary glands swell and it is possible allocation of a small amount of milk. In a month-old baby, the level of prolactin is stabilized and is 607 mU / L in boys and 628 mU / L in girls. As you grow up, the indices range from 40 to 400 mU / L. With this, the girls have these values higher than those of the guys.

• If the level of prolactin is higher than normal, it can lead to the development of prolactinoma, hypothyroidism, polycystic formations on the ovaries. Elevated values are observed in the last months of pregnancy.
• If the prolactin is below normal, then it causes problems with the childbearing function, birth bleeding, pregnancy retention, tumor lesions of the brain. Also, there are violations from the CNS and excessive growth of hair on the body, swelling.

To make the final diagnosis with changes in the level of prolactin, you should undergo a comprehensive examination of such specialists: gynecologist, neurologist, endocrinologist, psychiatrist.

Instrumental diagnostics

Another way to identify a tumor of the pituitary gland and its features (size, location, complications) is instrumental diagnostics. The patient is most often prescribed:

• Magnetic resonance imaging - is performed with the introduction of contrast agents that improve the visualization of the tumor. After contrasting, the outlines of prolactinoma are easily detected against the background of the pituitary gland, as well as its size and localization.
• Computer tomography - is performed with neoplasms more than 1 cm to assess the degree of bone destruction. During the diagnosis, the symptoms of the destruction of the Turkish saddle and hard meninges are revealed.
• Craniography is an X-ray study of the skull in a straight and lateral projection. The disease is characterized by a change in the shape and size of the Turkish saddle.

In addition to the above studies, consultation of the oculist is necessary. The doctor determines the compression of the optic nerves, reduced visual acuity and disruption of the oculomotor nerves. Mandatory consultation mammologist for the exclusion of breast tumors. The patient is given a mammogram and ultrasound of the glands. It is also necessary to assess the density of bone formations to exclude the development of osteoporosis.

Differential diagnosis

If a benign neoplasm is suspected in the pituitary gland, a complex of comprehensive studies is shown. Differential diagnosis of prolactinoma is carried out with such diseases:

• Endocrine pathologies.
• Hypothyroidism.
• Adrenogenital syndrome.
• Polycystic ovary syndrome.
• Somatic pathology, for example, kidney failure.
• Physiological galactorrhea (can persist in children under 3 years old and after lactation in women).
• Nerve reflex galactorrhea and hyperprolactinaemia.

Also, all possible hormonal and non-hormonal lesions of the pituitary gland are taken into account. Based on the results of differentiation, the doctor makes the final diagnosis and draws up a treatment plan.

[42], [43], [44], [45], [46], [47]

Treatment of the prolactinomas

The choice of treatment methods for prolactinoma is individual for each patient. The therapy prescribed by the doctor sets such goals:

• Restoration of pituitary functions.
• Reducing the size of the tumor or its complete removal.
• Recovery of prolactin levels in the blood.
• Elimination of pain symptoms and complications: headaches, visual disturbances and CNS, galactorrhea.

The treatment is handled by an endocrinologist and gynecologist. The patient is given medication with drugs that slow the growth of the tumor, reduce the level of prolactin and restore sexual functions in both men and women.

The main disadvantages of taking medications are that they cause side reactions and require a long time of use. In some cases, after stopping the taking of tablets, the level of the hormone again rises. If the prolactin levels remain normal within 6 months after the start of treatment, then therapy is suspended. In this case, the doctor recommends preventive courses with taking medications every 2 years. Such treatment can reduce the size of the tumor and avoid surgery.

Medications

For the treatment of prolactinoma, drugs from the dopamine receptor agonist group are used. Medicines are needed to normalize the level of prolactin, improve the pituitary gland, reduce the size of the tumor (observed after 6-12 weeks of treatment) and eliminate its pain symptoms.

Dopamine agonists:

The first generation - Ergot and its derivatives:

• Lysergic acid derivatives: bromocriptine, metisergide, Ronalin, Parlodel.
• Derivatives of aminoergoline: Lizurid, Turgulid, Mesulergin.
• Derived clavier: Pergolid, Metergoline.

The second generation is nonergod containing dopaminomimetic drugs: Hinagolide, Quinagolide.

III generation - selective inhibitors of D2-receptors of pituitary lactotropes: Cabergoline

Most often, patients are prescribed such drugs:

1. Norprolac

A drug from the pharmacotherapeutic group of B2-dopamine receptors. Suppresses the secretion of prolactin, without affecting the state of other pituitary hormones. Clinical decrease of the hormone is observed two hours after the drug intake and reaches a maximum after 4-6 hours with a single dosage. Has a prolonged action, which lasts about 24 hours. Prolonged use of the drug leads to the reverse development of prolactin-secreting neoplasms, that is, to reduce or delay their growth.

• Indications for use: high blood levels of the pituitary hormone, stimulating milk production, micro or macroadenomas of unknown origin, oligomenorrhea, amenorrhea, galactorrhea, infertility, decreased libido.
• Method of application: dosage is set individually for each patient. The initial dose is 0.025 mg once a day for three days. The next three days take 0.05 mg. From the seventh day of treatment, the daily dose is 0.075 mg. If necessary, it is possible to gradually increase the dosage to achieve the optimal therapeutic effect. In this case, the interval between dose changes should not be less than one week, and the maximum daily dosage should not exceed 0,075-0,15 mg.
• Side effects: headaches and dizziness, nausea, vomiting, drowsiness. In rare cases, there is a development of acute psychosis, which occurs after the drug is withdrawn. Also, a violation of appetite, abdominal pain, diarrhea, constipation, lowering blood pressure, nasal congestion. Very rarely there is a sharp drop in blood pressure, that is, orthostatic collapse.
• Contraindications: hypersensitivity to the components of the drug. With special care is prescribed for patients with mental illness in the anamnesis. And also for people whose work is associated with rapid motor or mental reactions.

Norprolac is available in a tablet form of release at 0.025; 0.05; 0.075 and 0.15 mg of the active ingredient.

2. Bromocriptine

Specific stimulant of dopamine receptors. Slows the secretion of hormones in the anterior pituitary gland, which are responsible for milk production. The use of this drug prevents lactation, inflammation of the breast tissue during breastfeeding and its engorgement. Restores ovarian function and menstrual cycle, promotes conception in women with hyperprolactin amenorrhea.

• Indications for use: suppression of prolactin production and normalization of its level, galactorrhea, stopping postpartum lactation.
• Method of administration: The drug is taken orally 2.5 mg twice a day during meals. Duration of treatment is 10-17 days. Therapy is stopped only for medical purposes. This is due to the fact that premature cancellation of the drug can lead to the restoration of lactation.
• Side effects: nausea, vomiting, headaches, lowering blood pressure, whitening of the limbs when cooling.
• Contraindications: intolerance of the components of the drug, the first trimester of pregnancy, heart rhythm disturbances, myocardial infarction, narrowing of the lumen of peripheral vessels, mental illness. During treatment, it is contraindicated to consume alcohol, oral contraceptives and drugs that depress the central nervous system.

Bromocriptine is available in the form of tablets of 2.5 mg and in the form of capsules of 5 and 10 mg.

3. Parlodel

A drug with an active component of bromocriptine. The active substance binds to the dopamine cerebral receptors D2. Has a stimulating effect, inhibiting the processes of the growth of prolactin molecules. Thanks to this, the pituitary-ovary system is affected, the lactation process is suppressed and the menstrual cycle is normalized. The drug reduces the severity of symptoms of Parkinson's disease, reduces the concentration of somatotropin, improves the condition with acromegaly. Eliminates the symptoms of depressive disorder.

• Indications for use: prolactinoma, hyperprolactinaemia against drug therapy, infertility in both sexes, menstrual cycle disorder, polycystic ovary syndrome, decreased libido, impotence, oligospermia. It is prescribed for adenomatous lesions of the pituitary gland, acromegaly, postpartum mastitis, and also if necessary to stop lactation. Used in preparation for surgical interventions as a means to reduce tumors and in postoperative therapy to reduce prolactin levels. The drug is effective in idiopathic Parkinson's disease and postencephalic parkinsonism.
• Usage: tablets are used orally. With prolactinoma, the dosage is chosen individually for each patient. As a rule, patients are prescribed 2.5-3.75 mg per day. The maximum dosage for infants under 12 years is 5 mg per day, for children over 12 years, up to 20 mg per day.
• Side effects: dizziness and headaches, dermatological reactions, tachycardia, alopecia, stool disorders, confusion, sleep and appetite disorders, tinnitus. It is also possible to develop asthenic conditions, hallucinations, various motor disorders, paresthesia and others.
• Contraindications: hypersensitivity to the components of the drug, gestosis, premenstrual syndrome, hypertension, lactation, benign mammological pathologies, diseases of the cardiovascular system, mental disorders. The use of medication during pregnancy is possible only if there are reasonable indications and strictly under medical supervision.
• Overdose: dyspepsia, lowering blood pressure, dizziness, hallucinations, tachycardia, drowsiness, fever, orthostatic hypotension. To eliminate the above symptoms, gastric lavage is indicated. To eliminate vomiting and hallucinations, metoclopramide is recommended.

Parlodel is available in the form of tablets in a package of 10 and 30 capsules.

4. Lizurid

The drug with antiserotoninovoy activity. Refers to dopamine receptor agonists.

• Indications for use: prolactinoma, hyperprolactinemic hypogonadism, acromegaly. It is also prescribed for Parkinsonism, allergic diseases and for the treatment of migraine (the frequency and intensity of seizures decreases).
• Method of administration: Oral by 0,025 mg 1-2 times a day. Duration of treatment is individual for each patient, therefore it is determined by the attending physician.
• Side effects: various dyspeptic phenomena, drowsiness, lowering of blood pressure, palpitations.
• Contraindications: hypersensitivity to the components of the drug, pregnancy. Tablets are not prescribed for patients with low blood pressure, peripheral circulatory disorders, ischemia, severe renal and hepatic impairment.

Lizuride is available in the form of tablets of 0.025 mg of the active ingredient.

5. Cabergoline

Dopamine D2-receptor agonist, derivative of ergot alkaloids. Stimulates the receptors of the pituitary gland, providing a pronounced and prolonged oppression of the secretion of the hormone of the anterior lobe - prolactin. Suppresses and stops physical lactation, has a therapeutic effect for menstrual disorders, infertility, decreased libido, impotence.

• Indication for use: macro and microadenomas of the pituitary gland, idiopathic hyperprolactinemia, suppression of lactation in the postpartum period.
• Dosage and administration: the drug is used orally, the dosage and duration of therapy depend on the stage of the pathological condition and the doctor's prescriptions, and therefore are individual for each patient.
• Contraindications: individual intolerance of the components of the drug, pregnancy, severe liver dysfunction, postpartum psychosis in the anamnesis. With special care, the drug is prescribed for patients with diseases of the cardiovascular system, ulcerative lesions of the stomach and duodenum.
• Side effects: headaches and dizziness, nausea, abdominal pain, lowering blood pressure, increased drowsiness. With the systematic use of the drug, there is soreness of the mammary glands, paresthesia, depressive state, asthenia.
• Overdose: fainting, hallucinations, nasal congestion. Treatment is symptomatic with control and maintenance of blood pressure.

Kabergoline is available in the form of a powder substance in polyethylene bags.

In addition to the above drugs, for the treatment of hormone-active pituitary adenoma can be appointed: Levodopa, Lergotril, Ciroheptadine, Quinagolide, Abergin, Peritol and other medications.

If dopamine agonists cause severe adverse reactions (headaches, dizziness, confusion, increased weakness, nausea and vomiting) in the patient, then Domperidon is recommended for their elimination. It must be taken an hour after the main medicine. To monitor the effectiveness of ongoing therapy, you should regularly check the level of prolactin in the serum.

Treatment of Prolactinoma by Dostinex

Effective drug from the pharmacotherapeutic group of dopamine agonists is Dostinex. Treatment of prolactinoma with Dostinex makes it possible to achieve persistent therapeutic results in a short period of time.

The active substance of the drug is cabergoline (ergoline derivative) with pronounced prolonged activity. Its mechanism of action is based on the blockade of hormone secretion by stimulating lactotrophic cells of the pituitary D2-dopamine receptors. High doses have a central stimulating dopaminergic effect on D2 receptors.

After ingestion, the drug is rapidly absorbed from the digestive tract. The maximum concentration is observed 1-4 hours after administration. The half-life with urine is 68-115 hours. Because of this half-life, equilibrium drug concentrations are reached after 28 days. The level of binding to plasma proteins is about 40%. Reduction in the level of prolactin is observed three hours after admission and persists for 7-28 days. The therapeutic effect in the period of postpartum lactation lasts about 14-21 days.

• Indications for use: prolactin-secreting adenoma of the pituitary gland, hyperprolactinaemia caused infertility, menstrual disorders, galactorrhea, impotence, decreased libido. Suppression of physiological lactation after childbirth, empty Turkish saddle syndrome, prevention of lactation after abortion or miscarriage.
• Method of application: for tumoral lesions of the anterior pituitary gland, patients are prescribed 0.25-0.5 mg 1-2 times a week on certain days. For example, every Tuesday or Tuesday and Friday. If necessary, the dosage is increased by 0.5 mg every month of treatment. As soon as the optimal dosage regimen is selected, the level of the hormone in the blood should be determined. In most cases, the rack therapeutic effect is achieved after 0.5-1 month of treatment.
• Side effects: headaches and dizziness, hypotension, insomnia, nausea and vomiting, abdominal pain. Also possible are various diarrheal phenomena, abdominal pains, hot flushes to the face, paresthesia. The most pronounced adverse reactions occur during the first two weeks of treatment. Strongly expressed adverse symptoms require withdrawal of the drug.
• Contraindications: hypersensitivity to the components of the remedy, hepatic insufficiency, late gestosis, postpartum psychosis in the anamnesis. The medication is not intended for use during pregnancy. If on a background of his reception there was a conception, then Dostineks is canceled.
• Overdose: nausea, vomiting, hallucinations, arterial hypotension, various dyspeptic disorders. To eliminate them, gastric lavage and further symptomatic therapy with normalization of blood pressure are indicated.
• Drug interaction: avoid simultaneous application with ergot alkaloids. It is also not recommended to use Butyrofenone, Phenothiazine, Metoclopramide, Thioksanthin, since Dostinex stimulates receptors for dopamine, which can lead to ineffective therapy. Under the ban enter drugs with antihypertensive effect, since they can cause arterial hypotension.

Dostineks has a tablet form of release - 8 tablets per pack with 0.5 mg of active substance each.

Vitamins

One of the methods of prevention, successful treatment and recovery after prolactinoma and other tumor lesions of the body is vitamins. Take useful substances after consultation with your doctor. Since some of them affect blood circulation in the tissues, they can aggravate the disease state.

The most useful vitamins for pituitary adenomas are A, E, C, as well as antineoplastic products based on cruciferous vegetables and flavonoids. In addition, there are already ready-made pharmacy vitamin complexes to maintain the health of the brain.

Consider the effect of certain vitamins on the functioning of the brain:

• B1 - thiamine reduces fatigue and anxiety, improves sleep quality and coordination. Its deficiency leads to the development of anxious and depressed states. Contained in oatmeal, nuts, buckwheat, pork and beef, fish.
• B2 - riboflavin speeds up mental reactions. It is a prophylactic against headaches, weakness and drowsiness. Contained in meat and dairy products.
• B3 - nicotinic acid is responsible for a healthy state, good memory and ability to focus. Contained in milk, fresh herbs, nuts, buckwheat, egg yolk.
• B6 - pyridoxine fights with anxiety and irritability, accelerates thought processes and raises the level of intelligence. The substance is synthesized in the body and is found in such foods: potatoes, bananas, beans, milk, cabbage, eggs.
• B9 - folic acid helps to eliminate insomnia, fatigue and apathetic condition. It is present in fresh vegetables, hard sorts of cheese, mushrooms, milk, apricots, meat. Synthesis of this vitamin is accelerated by eating bifidobacteria.
• B12 - cyanocobalamin is responsible for the normal switching of the body between sleep and wakefulness. Contained in sea kale, milk, shellfish, meat.
• C - ascorbic acid has antioxidant properties, protects the body from increased emotional and physical exertion. It helps to assimilate better to vitamins from group B. There are a lot of them in citrus fruits, vegetables and fruits.
• D - calciferol protects the body from malignant lesions, supports the elasticity of the walls of capillaries and large vessels. It stops oxidative processes. Formed in the body under the influence of solar radiation, in a small amount found in dairy products, eggs, fish oil, fresh parsley.
• E - tocopherol acetate fights with destructive processes in the body, strengthens the walls of blood vessels and prevents Alzheimer's disease. Present in unrefined sunflower oil, milk, beans, beef and pork liver.
• P - bioflavonoid protects the brain from hemorrhage, as it prevents the fragility of capillaries. There are in the leaves of green tea, mountain ash, rose hips, black currant, lemon.

Each of the above vitamins plays an important role in the normal functioning of the body, but it has the most pronounced effect in combination with other beneficial substances

Physiotherapeutic treatment

Tumor lesions of the brain, including hormonal-active neoplasms of the pituitary gland - this is a direct contraindication for most physiotherapy procedures. Physiotherapeutic treatment can start to stimulate tumor growth, so it is chosen very carefully taking into account all possible risks and complications.

Most often, patients are prescribed EHF - this is an extremely high-frequency therapy using millimeter wave waves. Radiation has a moderate penetrating ability in biological tissues and acts in the surface layers of the skin. It has a curative effect on the body with the help of activation of internal energy sources.

When exposed to a local painful area or biologically active points, it changes and stimulates the functioning of the vegetative nervous and endocrine systems. Increases the body's resistance to negative environmental factors.

Therapeutic effects:

• Stimulation of the nervous system.
• Improving the functioning of the immune system.
• Improve trophism of tissues.
• Stimulation of regeneration and repair processes.

Types of EHF-therapy are selected by the physiotherapist individually for each patient. Other physiotherapy, for example, massage of the collar zone or darsanval of the scalp (most often prescribed with severe headaches and dizziness) are contraindicated.

EHF is prescribed in immunodeficient conditions, endocrine system diseases, cardiological pathologies, long-term non-healing wounds and ulcers. Helps with diseases of the ENT organs, lesions of the genitourinary and nervous system, violations of the gastrointestinal tract.

Physioprocedure is contraindicated in cases of severe cardiac, renal or hepatic insufficiency, infectious diseases in the acute period, severe mental disorders, during pregnancy.

Alternative treatment

At the initial stages of development of prolactinoma, many patients resort to the use of non-traditional methods. Alternative treatment is possible only with the agreement of the attending physician, since some recipes can worsen a morbid condition.

• Take in equal proportions the herbs of melissa, valerian, plantain, sage and rowan fruits. Pour the ingredients 500 ml of boiling water and allow to brew until cooling. Strain and take ½ cup for the day before each meal.
• 10 g of dry herb St. John's wort pour a glass of boiling water and let it brew for 30 minutes. Take the drug 3-5 times a day for a tablespoon at a time.
• A tablespoon of fresh herbs of melissa chop and pour 500 ml of boiling water. After cooling, strain and take a couple of sips during the day. This infusion can be added to tea.
• Healing action has tincture hemlock, which can be purchased at the pharmacy. 10 drops of 10% alcohol tincture dilute ½ cup of water and divide into three meals throughout the day.

Before using alternative recipes, you should carefully check the tolerability of all plant components to avoid the risk of allergic reactions.

[48], [49], [50]

Herbal Treatment

Since the increased production of prolactin is often associated with stress and emotional experiences, then to reduce its level recommended recipes for the treatment of herbs:

• Take 100 g of hop cones and chop. Pour water at the rate of 30 grams of raw materials per 500 ml of water and bring to a boil over medium heat. After cooling, the broth should be filtered and can be taken on a tablespoon 3-5 times a day.
• Take in equal proportions the grass of melissa, the tops of St. John's wort, the fruits of hawthorn, passionflower and cones of hops. Thoroughly grind all the ingredients. 100 g of dry raw materials, pour 1.5 liters of boiling water and allow to brew until completely cooled. Strain and take a glass 30 minutes before meals throughout the day.
• Take in equal proportions sesame seeds, pumpkin, young ginger, herb primrose and honey. Thoroughly grind and mix all the ingredients until a uniform consistency is obtained. Take the drug for 1 teaspoon 3-4 times a day, regardless of food.

Treatment of hormone-active pituitary adenoma by this method is possible only with the appropriate medical clearance. Herbal therapy is carried out in conjunction with traditional medicamental methods.

Homeopathy

Another alternative treatment for prolactinoma is homeopathy. The choice of the drug depends on the nature of the course of the disease and the characteristics of the patient's body.

With hormonal-active adenoma of the pituitary gland and increased production of prolactin, such agents can be prescribed:

• Aconitum - the disease is caused by emotional and stressful overstrain, there are symptoms of hyperemia, increased irritability, agitation of the circulation.
• Belladonna - used as an analog of Aconitum, can be used to treat children.
• Glonoinum - frequent headaches and dizziness, feverish condition.
• Nux vomica - headaches, confusion, apathy.
• Arnica - frequent dizziness, hallucinations, impaired visual acuity.
• Uranium - increased milk production, pain in the temples, neck and forehead. Spasms in the throat, vomiting, purulent discharge from the nose.
• Iodatum - atrophy of mammary glands, inflamed lymph nodes. Atrophy of testicles, violation of sexual function.

All preparations are picked up by a homeopath, individually for each patient. As a rule, patients are prescribed several drugs at the same time to effectively stop the pathological symptoms of the disorder.

Surgery

If the detected tumor is large, surgical treatment is recommended. Before the operation, the patient is prescribed dopamine agonists, which make the pituitary adenoma more operable. The risk of frequent recurrence of the tumor is also taken into account, and therefore, after the operation, long-term medication is needed.

To date, microsurgical operations give good results and are conducted in a sparing mode. Patients may be assigned one of these therapies:

• Remote radiation therapy.
• Proton therapy.
• Radiosurgical treatment.
• Gamma therapy.

The entire treatment process is monitored using a tomograph. Neurosurgery is indicated for patients with the pressure of an overgrown tumor on adjacent tissues, impaired vision. Surgical treatment is also performed in complications of adenoma, such as cysts or hemorrhages.

Removal of prolactinoma

If the size of the benign tumor of the anterior lobe of the pituitary gland does not decrease, surgical intervention is recommended. Removal of prolactinoma is indicated in such cases:

• Lack of effectiveness of drug therapy.
• Individual intolerance of drugs for the treatment of neoplasm.
• Growth was swollen with the use of dopamine agonists.
• Increased growth of pathology during pregnancy.
• Apoplexy (necrosis of cells) of prolactinoma due to hemorrhage.
• Lesions of the optic nerves and severe visual impairment.

Removal of tumor formation is not carried out with a serious condition of the patient, inflammatory processes in the area of operation (nasal, frontal sinuses), severe forms of cardiovascular, renal or respiratory failure.

About 70% of operations are performed using transsphenoidal access, that is, removal through the nasal sinuses. This method does not injure the brain and has a minimum of complications. Operations with trepanation of the skull are extremely rare, for example, with giant or atypically located tumors, atypical structure of facial bones

Consider the main methods of removing prolactinoma:

1. Radiosurgery

The accuracy of this method is 0.5 mm, which allows you to work only on the adenoma, without affecting the surrounding nerve tissue. Radiosurgery is performed in such cases:

• The optic nerves are not damaged.
• The tumor is accompanied by neuroendocrinal syndrome.
• The size of the lesion is no more than 30 mm.
• The Turkish saddle has normal or slightly enlarged dimensions, and the adenoma does not go beyond it.

Before the procedure, the patient is poisoned with MRI or CT to compile an accurate three-dimensional tumor model. During the operation, the patient is placed on the couch and the head is fixed. The cyber knife acts remotely, it emits waves into the location of the adenoma. During the operation, the patient does not experience discomfort, hospitalization is not carried out. Radiosurgical methods are used to remove the remnants of prolactinoma after a classical operation or radiotherapy.

2. Transnasal removal

This method is recommended if the tumor is slightly outside the Turkish saddle. The procedure is carried out under local anesthesia. The surgeon inserts an endoscope with the camera into the nasal cavity. The doctor exposes the bone of the anterior sinus of the nose and uses a drill to access the Turkish saddle. After this, a gradual step-by-step removal of the parts of the neoplasm is made. After surgery, the Turkish saddle is sealed with the patient's tissues. At the end of the procedure, the patient remains in the hospital for 2-4 days.

3. Craniotomy

This is the most radical method of treatment. The operation involves opening the skull and is assigned in such cases:

• Asymmetric growth of the adenoma.
• The presence of secondary nodes in the tumor.
• Exit the formation outside the Turkish saddle.

Access to the affected organ is carried out front (opening of the frontal bones of the skull) or under the temporal bone. During the operation, the patient should lie on his side to avoid pinching the cervical veins and arteries supplying the brain with blood.

Removal of prolactinoma is carried out under general anesthesia. To extract the adenoma, use electric tweezers or an aspirator. In rare cases, the tumor is removed together with the pituitary gland because of its deep germination into healthy tissues. After this, the doctor returns the skin flap and places the seams. The patient spends 2-3 days in intensive care, where his condition is constantly monitored. After this, the patient is transferred to the ward with hospitalization for up to 20 days.

4. Radiation therapy

Treatment is conducted in one course from 4-5 sessions with an interval of 7-10 days. The duration of therapy takes about 5 weeks. During each procedure the patient receives an irradiation dose of about 180-200 rad, that is, for a course of about 5000 rad, depending on the size of the lesion. The effectiveness of this method is controversial, since only a third of patients showed improvement in the condition.

When choosing radiation therapy, the risk of possible complications is taken into account. Most often, patients face baldness, optic nerve damage, brain necrosis, hypopituitarism, neoplasia. Complications can make themselves felt in a few months, and in some cases several years after the procedure.

The main indicator of the effectiveness of the operation is a decrease in the level of prolactin to normal values within 24 hours after the procedure. According to medical statistics, the success of microadeno removal is 100%, and for tumors 1-3 cm to 80%. In this case, 65% of patients completely restored visual functions, in 20% - endocrine. If the tumor is of a giant size or is characterized by an atypical growth, the surgeon's task is to reduce the pressure on the surrounding tissues.

Removal of prolactinoma, like any operation, has certain risks. Possible consequences and complications of the operation:

• Bleeding.
• Visual impairment due to nerve damage.
• Meningitis due to infection.
• Spinal fluid flow.

In 13% of patients, relapse is observed, and in 5% of cases, death occurs during surgery. In this case, the detected prolactinomas, which do not cause symptoms, can not be removed. It is necessary to regularly check the hormone in the blood and make a planned magnetic resonance imaging annually.

Diet and lifestyle with prolactinoma

For normal operation of the pituitary gland and the whole body, a healthy diet is needed. Diet with prolactinoma should consist of foods rich in folic acid. This substance stimulates blood and testosterone production, increases the level of estrogens and improves the digestibility of protein foods.

Useful products for the pituitary:

• Chicken eggs are a source of lutein, they contain a lot of vitamins and microelements.
• Chicken meat is rich in protein, which acts as a building material for new cells. Contains vitamins of group B and selenium.
• Fatty varieties of fish - for the pituitary gland will be useful herring, salmon, mackerel. Stimulate the production of hormones, maintain a balance of endocrine glands, prevent the deposition of cholesterol.
• Walnuts - contain vitamins A, B, C, as well as iron, zinc, cobalt, magnesium and iodine. Stimulate the normal functioning of the brain and slow the aging process.
• Spinach - contains a large amount of iron, which maintains the normal circulation of the pituitary gland. A antioxidant action prevents the development of adenoma.
• Sea kale is the source of iodine. It struggles with irritation, sleep disorders, fatigue. Contributes to providing the brain with oxygen.
• Black chocolate - stimulates the work of the brain and processes in the pituitary gland. Activates nerve cells, stimulates blood vessels.

From the diet should be excluded foods that increase the level of prolactin in the blood - gluten-containing foods. Under the ban comes white bread, baked pastries, cakes, smoked products, sausages and sausages, alcohol, fatty meat and salt. During treatment, you should limit the use of preservatives, dyes, and taste enhancers to the maximum. They are capable of causing disturbances in the osmotic state of brain cells and the conductivity of nerve fibers.

[51], [52]

Prolactinoma and sports, weightlifting

The possibility of physical exertion in case of neoplastic lesions of the brain depends entirely on the type of neoplasm, the mechanism of its origin and the symptomatology. Prolactinoma and sports, weightlifting, swimming and much more are recommended only if the doctor gives the appropriate permission.

Typically, for patients in whom the tumor has not been removed there are certain limitations. This is due to the fact that accelerated metabolism and increased blood supply can cause an increase in the size of the adenoma. Many physiotherapy procedures with stimulating action also fall under the ban.

With regard to patients in the postoperative period, during recovery, minor physical exertion is permitted. They contribute to the normal functioning of the body. But all the same you should be careful, because excessive overvoltage can become a trigger mechanism for relapse of the disease.

Can I sunbathe with prolactinoma?

Many patients who have had a tumor in the anterior pituitary gland are wondering if it is possible to sunbathe. With prolactinoma, the fire is allowed, but only if all safety rules are observed:

• Take a sun bath should be in the morning or evening hours, lunch time from 11: 00-16: 00 is better to spend in a cool room.
• It is necessary to provide the skin with the necessary protection from ultraviolet radiation in the form of a special cream.
• To protect from sunstroke, you need to put on your hat, hat or panama. Sunglasses will not be superfluous either.
• Stock up with clean cool water to maintain water balance during the rest. Do not drink alcohol or cold drinks during sunbathing.
• Do not lie under the sun in one pose. To get a beautiful tan is better to move.
• Avoid all kinds of injuries, especially craniocerebral injuries.

The above recommendations will allow you to safely and profitably spend your vacation in the sun. Solar baths are useful, as they supply the body with vitamin D, which is necessary for the normal functioning of the brain.

[53]

Prevention

Specific prophylaxis of the hormonal-active tumor of the pituitary gland is absent, since the etiology of its origin has not been fully studied. To reduce the risk of this disease, you should avoid craniocerebral trauma, as well as prolonged intake of oral contraceptives. During pregnancy, you must create all the conditions for its normal course. It is also recommended to take computer tomography and ophthalmological examination every year, to take tests every six months to determine the level of hormones.

[54], [55], [56], [57],

Forecast

Prolactinoma has a favorable prognosis in only a third of all cases of the disease. Prognostic indicators depend on the size, hormonal activity and symptoms of the pathological condition. Relapse occurs in half the cases within five years after the first treatment. Also, we should not exclude the risk of tumor degeneration into a malignant tumor, which has a very unfavorable outcome.

[58], [59], [60], [61], [62]