In view of her inherited predisposition for PA, this lesion likely represents a microprolactinoma
. However, since she has now commenced puberty and her prolactin is only marginally raised and stable, dopamine agonist treatment has not been commenced.
in India showed microprolactinoma
in 35.8% cases of HP, 27.8% idiopathic HP, 16 % non-functioning pituitary macroadenoma, 12.8% PCOS, 5.3% drugs and 2.1% hypothyroidism.
Estrogen therapy may be used to replace dopamine agonists in women with idiopathic Hyperprolactinemia (IH) or microprolactinoma
who do not want to become pregnant and those suffering from estrogen deficiency, particularly if they are resistant to or intolerant of dopamine agonists.
In the absence of pregnancy and breast-feeding, a serum PRL level of >600 ng/mL is highly suggestive of a macroprolactinoma.12 PRL concentrations >250 ng/mL suggest a microprolactinoma
or a nonfunctioning adenoma.
Some of these patients may have radiologically undetected microprolactinoma
, however, some may present with macroprolactinemia.
(2008) have documented several cases of prolactinoma (lactotroph adenoma) following high-dose estrogen treatment in MTF patients with normal serum prolactin levels prior to therapy, as well as the formation of a pituitary microprolactinoma
in a patient on normal-dose estrogen for 14 years.
Asymptomatic patients harboring microprolactinomas
do not need to be prescribed dopamine agonists.3 Symptomatic prolactin-secreting microadenomas may be treated with bromocriptine or cabergoline before pregnancy, to lower prolactin levels, decrease tumour size, and restore gonadal function.
Guidelines of Pituitary Society support that PRL values up to 100 [micro]g/L (~2000mU/L) may be due to psychotropic medications, estrogens, functional causes, or microprolactinomas
, while macroadenomas are associated with levels over 250 [micro]g/L (~5000 mU/L) .
For example, it has been described that macroprolactinomas are significantly more vascular than microprolactinomas
, and Turner et al.
It was notable that, in the CD + PRL group, the normalization rate for patients with macroprolactinomas was significantly lower than that for patients with microprolactinomas
. Since complete resection of microadenomas was possible, it is perhaps not surprising that the normalization rates for patients with microadenomas exceeded 95% for both groups.