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Breast Self Exam May Aid in Pituitary Tumor Diagnosis
Thousand Oaks, CA – July 10, 2006
Manipulating the nipple and checking for discharge is an important yet often neglected step in a
woman’s breast self exam. Discharge may be an indication of the presence of the most common
type of pituitary tumor called a prolactinoma.
According to the Pituitary Network Association, a prolactinoma is a benign tumor of the pituitary
gland that produces a hormone called prolactin. Prolactin-producing tumors exist "silently" in up
to 5-10 percent of the adult population.
Symptoms of a prolactinoma are caused by too much prolactin in the blood
(hyperprolactinemia) or by pressure of the tumor on surrounding tissues. Prolactin stimulates the
breast to produce milk during pregnancy. After delivery of the baby, a mother's prolactin levels fall
unless she breastfeeds her infant. Each time the baby nurses, prolactin levels rise to maintain
In women, high blood levels of prolactin often cause infertility and changes in menstruation. In
some women, periods may disappear altogether. In others, periods may become irregular or
menstrual flow may change. Women who are not pregnant or nursing may begin producing
breast milk. Some women may experience a loss of libido (interest in sex). Intercourse may
become painful because of vaginal dryness.
The normal prolactin level is < 20 ng/ml. In most women the tumors are detected when they are
small (microadenomas) and the prolactin level is only moderately elevated (30 - 300 ng/ml). In
contrast, in men prolactinomas are usually not detected until they are large (macroadenomas),
most have prolactin levels over 500 ng/ml. A minority of patients with large tumors may have
bleeding into the tumor (pituitary apoplexy) causing relatively sudden onset of headache, visual
loss, double vision, and/or pituitary failure.
The diagnosis of a prolactinoma is confirmed by demonstrating persistently elevated blood
levels of prolactin. A prolactin level of over 150-200 ng/ml is almost always due to a prolactin
secreting pituitary adenoma. In all patients with suspected pituitary tumors, a complete pituitary
hormone evaluation should be performed. This testing is especially important in patients with
potentially large tumors who are likely to have some degree of pituitary failure (hypopituitarism).
It is important to note that moderate elevations of prolactin (30 - 200 ng/ml) can occur as a
result of several other causes, which must be excluded prior to diagnosing a pituitary tumor. The
most common causes are pregnancy or in the post-partum period, stress (discomfort, exercise,
low blood sugar), low thyroid function (hypothyroidism), kidney failure, liver failure, medications
(such as anti-ulcer and antidepressants), and "stalk effect".
At one time, oral contraceptives were thought to contribute to the development of
prolactinomas. However, this is no longer thought to be true. Patients with a prolactinoma treated
with bromocriptine may also take oral contraceptives. Similarly, post-menopausal estrogen
replacement is safe in patients with a prolactinoma treated with medical therapy or surgery.
For a step-by-step self breast exam guide, visit www.WebMD.com
. If nipple discharge is
present, visit www.pituitary.org
to find a specialized physician in your area.
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