Prolactinoma medical therapy: Difference between revisions

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Latest revision as of 23:49, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2], Faizan Sheraz, M.D. [3]

Overview

Medical therapy for prolactinoma includes dopamine agonists (either cabergoline or bromocriptine). The goals of treatment include lowering the prolactin secretion to normal, reduction of tumor size, correction of any visual abnormalities, and restoration of normal pituitary function.

Medical Therapy

Medical therapy for prolactinoma includes dopamine agonists (cabergoline or bromocriptine).^[1]^[2]^[3]^[4]^[5]
- Preferred regimen: Cabergoline 0.25 mg PO twice weekly or 0.5 mg PO once per week
  - The dose may be gradually increased every 4 weeks as needed
  - The maximum dose can be administered up to 1 mg PO twice per week
- Alternative regimen: Bromocriptine 1.25 mg PO once daily at bedtime for 1 week
  - The dose may be gradually increased every 3 to 7 days as needed and taken in divided doses

These drugs reduce the tumor size in approximately 85% of cases and lower the prolactin concentration to normal in more than 90% of patients.
Both drugs have been approved by the U.S Food and Drug Administration for the treatment of hyperprolactinemia.

Medical therapy in pregnancy

Bromocriptine is considered safe to use during pregnancy.^[1]

Indications for withdrawal of dopamine agonist therapy

Dopamine therapy can be tapered down to lower doses if the patient fulfills the following criteria:^[1]
- Normal prolactin level for at least 2 years.
- Reduction in tumor size by at least 50%.
- No compression of optic chiasm.
Drug cessation can be tried if:
- Cavernous sinus invasion is not present.

Radiation Therapy

Rarely, radiation therapy is used if medical therapy and surgery fail to reduce prolactin concentration. Depending on the size and location of the tumor, radiation is delivered either in low doses over the course of 5 to 6 weeks or in a single high dose. Radiation therapy is effective in approximately 30% of cases.^[2]

References

↑ ^1.0 ^1.1 ^1.2 Liu JK, Couldwell WT (2004). "Contemporary management of prolactinomas". Neurosurg Focus. 16 (4): E2. PMID 15191331.
↑ ^2.0 ^2.1 Colao A, Savastano S (2011). "Medical treatment of prolactinomas". Nat Rev Endocrinol. 7 (5): 267–78. doi:10.1038/nrendo.2011.37. PMID 21423245.
↑ Nomikos P, Buchfelder M, Fahlbusch R (2001). "Current management of prolactinomas". J Neurooncol. 54 (2): 139–50. PMID 11761431.
↑ "Prolactinoma | NIDDK".
↑ Ciccarelli E, Camanni F (1996). "Diagnosis and drug therapy of prolactinoma". Drugs. 51 (6): 954–65. PMID 8736617.

Template:WikiDoc Sources

[pmid15191331-1] 1.0 ^1.1 ^1.2 Liu JK, Couldwell WT (2004). "Contemporary management of prolactinomas". Neurosurg Focus. 16 (4): E2. PMID 15191331.

[pmid21423245-2] 2.0 ^2.1 Colao A, Savastano S (2011). "Medical treatment of prolactinomas". Nat Rev Endocrinol. 7 (5): 267–78. doi:10.1038/nrendo.2011.37. PMID 21423245.

[pmid11761431-3] Nomikos P, Buchfelder M, Fahlbusch R (2001). "Current management of prolactinomas". J Neurooncol. 54 (2): 139–50. PMID 11761431.

[urlProlactinoma_|_NIDDK-4] "Prolactinoma | NIDDK".

[pmid8736617-5] Ciccarelli E, Camanni F (1996). "Diagnosis and drug therapy of prolactinoma". Drugs. 51 (6): 954–65. PMID 8736617.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Prolactinoma}}
-{{CMG}} {{AE}}{{Faizan}}
+{{CMG}}; {{AE}}{{Anmol}}, {{Faizan}}
 ==Overview==
-The goal of treatment is to:
+Medical therapy for prolactinoma includes [[dopamine agonists]] (either [[cabergoline]] or [[bromocriptine]]). The goals of treatment include lowering the [[prolactin]] secretion to normal, reduction of [[tumor]] size, correction of any [[visual]] abnormalities, and restoration of normal [[pituitary]] function.
-*Return prolactin secretion to normal
-*Reduce tumor size
-*Correct any visual abnormalities
-*Restore normal pituitary function.
-As mentioned above, the impact of stress should be ruled out before the diagnosis of prolactinoma is given.  Exercise can significantly reduce stress and, thereby, prolactin levels.  It should also be noted that higher prolactin levels may contribute to the development of prolactinomas so the diagnosis can be self-fulfilling if the original cause is stress. In the case of very large tumors, only partial reduction of the prolactin levels may be possible.
 ==Medical Therapy==
-[[Dopamine]] is the chemical that normally inhibits prolactin secretion, so doctors may treat prolactinoma with [[bromocriptine]] or [[cabergoline]], drugs that act like [[dopamine]]. This type of drug is called a [[dopamine agonist]].  These drugs shrink the tumor and return prolactin levels to normal in approximately 80% of patients.  Both have been approved by the [[Food and Drug Administration]] for the treatment of [[hyperprolactinemia]]. Bromocriptine is the only dopamine agonist approved for the treatment of infertility.  Another dopamine agonist, [[pergolide]], is available in the U. S., but is not approved for treating conditions that cause high blood levels of prolactin.
+*Medical therapy for prolactinoma includes [[Dopamine agonist|dopamine agonists]] ([[cabergoline]] or [[bromocriptine]]).<ref name="pmid15191331">{{cite journal| author=Liu JK, Couldwell WT| title=Contemporary management of prolactinomas. | journal=Neurosurg Focus | year= 2004 | volume= 16 | issue= 4 | pages= E2 | pmid=15191331 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15191331  }} </ref><ref name="pmid21423245">{{cite journal| author=Colao A, Savastano S| title=Medical treatment of prolactinomas. | journal=Nat Rev Endocrinol | year= 2011 | volume= 7 | issue= 5 | pages= 267-78 | pmid=21423245 | doi=10.1038/nrendo.2011.37 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21423245  }} </ref><ref name="pmid11761431">{{cite journal| author=Nomikos P, Buchfelder M, Fahlbusch R| title=Current management of prolactinomas. | journal=J Neurooncol | year= 2001 | volume= 54 | issue= 2 | pages= 139-50 | pmid=11761431 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11761431  }} </ref><ref name="urlProlactinoma | NIDDK">{{cite web |url=https://www.niddk.nih.gov/health-information/endocrine-diseases/prolactinoma |title=Prolactinoma &#124; NIDDK |format= |work= |accessdate=}}</ref><ref name="pmid8736617">{{cite journal |vauthors=Ciccarelli E, Camanni F |title=Diagnosis and drug therapy of prolactinoma |journal=Drugs |volume=51 |issue=6 |pages=954–65 |year=1996 |pmid=8736617 |doi= |url=}}</ref>
-[[Bromocriptine]] is associated with side effects such as [[nausea]] and [[dizziness]].  To avoid these side effects, it is important for bromocriptine treatment to start slowly.
+**Preferred regimen: [[Cabergoline]] 0.25 mg PO twice weekly or 0.5 mg PO once per week
-Bromocriptine treatment should not be interrupted without consulting a qualified [[endocrinologist]].  Prolactin levels often rise again in most people when the drug is discontinued.  In some, however, prolactin levels remain normal, so the doctor may suggest reducing or discontinuing treatment every two years on a trial basis.
+***The dose may be gradually increased every 4 weeks as needed
-[[Cabergoline]] is also associated with side effects such as [[nausea]] and [[dizziness]], but these may be less common and less severe than with bromocriptine.  As with bromocriptine therapy, side effects may be avoided if treatment is started slowly.  If a patient's prolactin level remains normal for 6 months, a doctor may consider stopping treatment.  Cabergoline should not be interrupted without consulting a qualified endocrinologist.
+***The maximum dose can be administered up to 1 mg PO twice per week
+**Alternative regimen: [[Bromocriptine]] 1.25 mg PO once daily at bedtime for 1 week
+***The dose may be gradually increased every 3 to 7 days as needed and taken in divided doses
+*These [[drug]]s reduce the [[tumor]] size in approximately 85% of cases and lower the [[prolactin]] concentration to normal in more than 90% of patients.
+*Both drugs have been approved by the U.S [[Food and Drug Administration]] for the treatment of [[hyperprolactinemia]].
+===Medical therapy in pregnancy===
+*[[Bromocriptine]] is considered safe to use during [[pregnancy]].<ref name="pmid15191331">{{cite journal| author=Liu JK, Couldwell WT| title=Contemporary management of prolactinomas. | journal=Neurosurg Focus | year= 2004 | volume= 16 | issue= 4 | pages= E2 | pmid=15191331 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15191331  }} </ref>
+===Indications for withdrawal of dopamine agonist therapy===
+*[[Dopamine]] therapy can be tapered down to lower doses if the patient fulfills the following criteria:<ref name="pmid15191331">{{cite journal| author=Liu JK, Couldwell WT| title=Contemporary management of prolactinomas. | journal=Neurosurg Focus | year= 2004 | volume= 16 | issue= 4 | pages= E2 | pmid=15191331 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15191331  }} </ref>
+**Normal [[prolactin]] level for at least 2 years.
+**Reduction in [[tumor]] size by at least 50%.
+**No compression of [[optic chiasm]].
+*Drug cessation can be tried if:
+**[[Cavernous sinus]] invasion is not present.
+==Radiation Therapy==
+*Rarely, [[radiation therapy]] is used if medical therapy and [[surgery]] fail to reduce [[prolactin]] concentration. Depending on the size and location of the [[tumor]], [[radiation]] is delivered either in low doses over the course of 5 to 6 weeks or in a single high dose. [[Radiation therapy]] is effective in approximately 30% of cases.<ref name="pmid21423245">{{cite journal| author=Colao A, Savastano S| title=Medical treatment of prolactinomas. | journal=Nat Rev Endocrinol | year= 2011 | volume= 7 | issue= 5 | pages= 267-78 | pmid=21423245 | doi=10.1038/nrendo.2011.37 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21423245  }} </ref>
 == References ==
 {{Reflist|2}}
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