Which symptom combination is typical of prolactinoma in females?

• A. Galactorrhea alone
• B. Amenorrhea alone
• C. Amenorrhea and galactorrhea
• D. Infertility without galactorrhea

Answer: (C)

Hyperprolactinemia from a pituitary prolactinoma drives two main effects that explain the typical female presentation. First, excess prolactin stimulates breast tissue, leading to galactorrhea. Second, high prolactin suppresses GnRH release from the hypothalamus, which lowers LH and FSH from the pituitary and disrupts ovulation, producing amenorrhea. The combination of amenorrhea and galactorrhea is the classic pattern because it reflects both the lactogenic effect of prolactin and its suppression of the reproductive axis. Infertility or galactorrhea alone can occur with other issues, but having both symptoms together most strongly points to a prolactin-secreting tumor. If the tumor is larger, headaches or visual changes may also appear due to mass effect.