Prolactinoma medical therapy: Difference between revisions
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{{CMG}} {{AE}}{{Anmol}},{{Faizan}} | {{CMG}} {{AE}}{{Anmol}},{{Faizan}} | ||
==Overview== | ==Overview== | ||
Medical therapy for prolactinoma includes [[dopamine agonists]] (either [[ | Medical therapy for prolactinoma includes [[dopamine agonists]] (either [[cabergoline]] or [[bromocriptine]]). | ||
The goal of treatment is to return [[prolactin]] secretion to normal, reduce [[tumor]] size, correct any [[visual]] abnormalities and restore normal [[pituitary]] function.<ref name="pmid21296991">{{cite journal| author=Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA et al.| title=Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. | journal=J Clin Endocrinol Metab | year= 2011 | volume= 96 | issue= 2 | pages= 273-88 | pmid=21296991 | doi=10.1210/jc.2010-1692 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21296991 }} </ref> | The goal of treatment is to return [[prolactin]] secretion to normal, reduce [[tumor]] size, correct any [[visual]] abnormalities, and restore normal [[pituitary]] function.<ref name="pmid21296991">{{cite journal| author=Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA et al.| title=Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. | journal=J Clin Endocrinol Metab | year= 2011 | volume= 96 | issue= 2 | pages= 273-88 | pmid=21296991 | doi=10.1210/jc.2010-1692 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21296991 }} </ref> | ||
==Medical Therapy== | ==Medical Therapy== | ||
*Medical therapy for prolactinoma includes [[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> | *Medical therapy for prolactinoma includes [[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> | ||
**Preferred regimen: [[Cabergoline]] | **Preferred regimen: [[Cabergoline]] 0.25 mg PO twice weekly or 0.5 mg PO once weekly. | ||
***The dose may be gradually increased every 4 weeks as needed. | ***The dose may be gradually increased every 4 weeks as needed. | ||
*** | ***The maximum dose can be administered up to 1 mg PO twice weekly. | ||
**Alternative regimen: [[Bromocriptine]] | **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. | ***The dose may be gradually increased every 3 to 7 days as needed and taken in divided doses. | ||
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===Indications for withdrawal of Dopamine agonist therapy=== | ===Indications for withdrawal of Dopamine agonist therapy=== | ||
*Dopamine therapy can be tapered down to lower doses if | *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 | **Normal [[prolactin]] level for at least 2 years. | ||
**Reduction in tumor size by | **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 | 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. | ||
== References == | == References == | ||
Revision as of 19:37, 8 August 2017
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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 goal of treatment is to return prolactin secretion to normal, reduce tumor size, correct any visual abnormalities, and restore normal pituitary function.[1]
Medical Therapy
- Medical therapy for prolactinoma includes dopamine agonists (cabergoline or bromocriptine).[2]
- Preferred regimen: Cabergoline 0.25 mg PO twice weekly or 0.5 mg PO once weekly.
- The dose may be gradually increased every 4 weeks as needed.
- The maximum dose can be administered up to 1 mg PO twice weekly.
- 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 weekly.
- These drugs reduce the tumor size in approximately 85% of cases and return 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 in pregnancy.[2]
Indications for withdrawal of Dopamine agonist therapy
- Dopamine therapy can be tapered down to lower doses if the patient fulfills the following criteria:[2]
- 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.
References
- ↑ Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA; et al. (2011). "Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline". J Clin Endocrinol Metab. 96 (2): 273–88. doi:10.1210/jc.2010-1692. PMID 21296991.
- ↑ 2.0 2.1 2.2 Liu JK, Couldwell WT (2004). "Contemporary management of prolactinomas". Neurosurg Focus. 16 (4): E2. PMID 15191331.