Prolactinomas. Clinical presentation, radiologic assessment, and therapeutic options

Of the pituitary tumors, the prolactinoma is the most common, characteristically causing amenorrhea/galactorrhea in women and symptoms secondary to mass effect in men. Direct coronal CT scanning with rapid infusion contrast enhancement is now considered the most sensitive and specific method for evaluating the pituitary. Normally the gland is either homogeneous or heterogeneous in a repetitive fashion, and measures up to 9-10 mm in height. Adenomas typically are hypodense lesions in the anterior lobe associated with mass effect--superior surface convexity, gland enlargement, bony erosion, infundibulum displacement, or vascular "tuft" shift. High field superconductive MRI is thought to be superior to CT for evaluation of macroadenomas and may soon surpass CT in the evaluation of microadenomas. Treatment remains controversial. Perhaps surgery is the best alternative for women 15 to 30 years of age with microadenomas producing prolactin less than 100 ng/ml. Patients who are either beyond the child-bearing years, present with tumors greater than 10 mm in diameter, or have microadenomas producing prolactin greater than 100 ng/ml may be better served by medical therapy using bromocriptine or pergolide mesylate.