Prolactinoma medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
*Medical therapy for prolactinoma includes [[dopamine]] | *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 | 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> | ||
**Preferred regimen: [[Cabergoline]] 0.25 mg PO twice weekly or 0.5 mg PO once per week | **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 dose may be gradually increased every 4 weeks as needed | ||
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*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. | *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]]. | *Both drugs have been approved by the U.S [[Food and Drug Administration]] for the treatment of [[hyperprolactinemia]]. | ||
===Medical | ===Medical therapy in pregnancy=== | ||
*[[Bromocriptine]] is considered safe | *[[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=== | ===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> | *[[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. | **Normal [[prolactin]] level for at least 2 years. | ||
**Reduction in tumor size by at least 50%. | **Reduction in [[tumor]] size by at least 50%. | ||
**No compression of [[optic chiasm]]. | **No compression of [[optic chiasm]]. | ||
*Drug cessation can be tried if: | *Drug cessation can be tried if: | ||
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==Radiation Therapy== | ==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. | *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 == | == References == | ||
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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
- Preferred regimen: Cabergoline 0.25 mg PO twice weekly or 0.5 mg PO once per week
- 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.