Hyperprolactinemia, Prolactinoma: Symptoms, Complaints, Signs

A microadenoma (tumor size: < 1 cm) is often clinically asymptomatic and occasionally presents with symptoms of hyperprolactinemia. The following symptoms and complaints may indicate hyperprolactinemia:

Symptoms in women

  • Galactorrhea (abnormal breast milk discharge; seen in approximately 25-40% of women with hyperprolactinemia).
  • Secondary hypogonadism/gonadal hypofunction (estrogen deficiency).
    • Arrhythmias
      • Amenorrhea – no menstrual bleeding until age 15 (primary amenorrhea) or no menstrual bleeding for > 90 days (secondary amenorrhea) [anovulation].
      • Oligomenorrhea – the interval between bleeding is > 35 days and < 90 days, ie, bleeding occurs too infrequently [corpus luteum insufficiency(/luteal weakness; possibly anovulation/absence of menstrual bleeding for more than three months].
    • Decreased libido
    • Sterility (corpus luteum insufficiency/yellow body weakness; approximately 20% of all women with infertility have hyperprolactinemia).
    • Osteoporosis
    • Atrophy (tissue loss) of the vaginal epithelium (vaginal epithelium) (possibly dyspareunia / pain during intercourse).
  • Acne
  • Hirsutism

Symptoms in men

  • Galactorrhea (very rare)
  • Secondary hypogonadism/gonadal hypofunction (testosterone deficiency).
    • Impotence (erectile dysfunction (ED), erectile dysfunction).
    • Infertility (infertility)
    • Loss of libido
    • Oligospermia (< 15 million sperm/semen cells per ml of ejaculate; see under spermiogram).
    • Decreased beard growth
    • Reduced muscle mass
    • Osteopenia (reduction in bone density) or osteoporosis (bone loss) (in chronic and marked hyperprolactinemia),

Other symptoms

  • Weight gain
  • Possibly psychosyndrome (depression; anxiety, etc.)

A macroadenoma (tumor size: ≥ 1 cm) shows in particular displacement symptoms in addition to the symptoms of hyperprolactinemia.Macroadenomas are more common in men than in women. The following symptoms and complaints may indicate a prolactinoma:

Symptoms in women

  • Amenorrhea – no menstrual bleeding until 15 years of age (primary amenorrhea) or no menstrual bleeding for > 90 days (secondary amenorrhea) [anovulation].
  • Galactorrhea (milk flow) (- 80%).
  • Cephalgia (headache)
  • Infertility (infertility)
  • Visual disturbances/facial field defects (bitemporal hemianopsia/visual disturbance with loss of both temporal visual fields; up to 45%) or other neurological symptoms (e.g., more severe headaches) and cranial nerve compression (in larger pituitary and near-pituitary tumors)
  • Nausea (nausea)/vomiting.

Symptoms in men

  • Impotence (erectile dysfunction (ED), erectile dysfunction).
  • Infertility (inability to conceive).
  • Loss of libido
  • Galactorrhea (milk flow) and gynecomastia (enlargement of the mammary glands) (very rare).
  • Cephalgia (headache)
  • Visual disturbances/facial field defects (bitemporal hemianopsia/visual disturbance with loss of both temporal visual fields) or other neurological symptoms (e.g., headache) and cranial nerve compression
  • Nausea (vomiting)/vomiting.

Signs or symptoms of anterior pituitary insufficiency (HVL insufficiency; hypopituitarism) (35% of cases).

  • Abdominal – in the abdomen – fat deposits.
  • Adynamia (general exhaustion or a marked lack of strength and drive).
  • Arterial hypotension – low blood pressure.
  • Paleness
  • Bradycardia – too slow heartbeat: < 60 beats per minute.
  • Depression
  • Weight loss
  • Hypoglycemia (low blood sugar)
  • Cold intolerance (cold intolerance)
  • Fatigue
  • Osteoporosis (bone loss)
  • Waning of the secondary hair
  • Dwarfism