Snapshot A 36-year-old woman presents to the physician with complaint of nipple discharge. She states that she has observed a milky discharge coming from both of her nipples for the past 3 weeks. She notes that other abnormal symptoms she has experienced include intermittent headaches and decreased libido. Physical examination reveals a severe visual field defect, depicted in the image. Introduction Overview a prolactinoma is a non-cancerous pituitary tumor that overproduces the hormone prolactin treatment is usually with medication to restore a normal prolactin level or surgical resection Epidemiology incidence most common pituitary adenoma (40% of all pituitary adenomas) demographics more common in women than men peak prevalence in women ages 25-34 years location pituitary gland login to view 1 more bullet Pathophysiology prolactinomas arise from monoclonal expansion of pituitary lactotrophs results in excess synthesis and secretion of prolactin login to view 1 more bullet can cause hypopituitarism from mass effect Presentation Imaging MRI or CT scan of the pituitary hypothalamic area indications determine if a mass lesion is present Studies Serum prolactin levels measure on 1 or more occassions Serum pregnancy test rule out pregnancy as the cause of secondary amenorrhea in reproductive-aged females Serum TSH rule out the possibility of ↑ prolactin level secondary to an elevated TRH level Serum testosterone levels measure in men presenting with symptoms of hypogonadism Treatment Medical bromocriptine or cabergoline (dopamine agonists) indications login to view 2 more bullets Surgical surgical resection indications login to view 2 more bullets Complications Cranial nerve palsies due to mass effect Infertility