Prolactinoma

Patient presents with symptoms suggestive of prolactinoma, including galactorrhea, amenorrhea, oligomenorrhea, infertility, decreased libido, erectile dysfunction, and headaches.  On physical examination, galactorrhea may be present upon breast expression.  Visual field deficits may be noted depending on tumor size and compression of the optic chiasm.  Laboratory findings reveal elevated prolactin levels.  Differential diagnosis includes drug-induced hyperprolactinemia, hypothyroidism, pregnancy, and other pituitary adenomas.  Brain MRI with pituitary protocol is ordered to confirm the diagnosis and assess tumor size and location, including assessment for macroadenoma versus microadenoma.  Initial management may include dopamine agonists such as cabergoline or bromocriptine to reduce prolactin levels and tumor size.  Treatment goals focus on normalizing prolactin levels, restoring gonadal function, and improving related symptoms.  Surgical resection via transsphenoidal surgery may be considered in cases of resistance to medical therapy, significant tumor compression, or neurological symptoms.  Patient education includes discussion of medication side effects, potential complications, and the importance of regular monitoring of prolactin levels, tumor size, and visual fields.  ICD-10 code D35.2, Pituitary adenoma, is documented.  CPT codes for relevant procedures, such as MRI brain 70551 (without contrast) or 70552 (with contrast), and potentially surgery codes, will be documented upon completion of the procedures.  Continued surveillance and follow-up are crucial for long-term management of prolactinoma.