Prolactinoma medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]
Overview
Medical therapy for prolactinoma includes dopamine agonists. Dopamine is the chemical that normally inhibits prolactin secretion. The goal of treatment is to:
- 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
Medical therapy for prolactinoma includes dopamine agonists (bromocriptine or cabergoline)
Bromocriptine: 25 mg PO od for 1 weeks
The dose is gradually increased every 3 to 7 days as needed and taken in divided doses with meals or at bedtime with a snack. Most people are successfully treated with 7.5 mg a day or less, although some people need 15 mg or more each day.
Cabergoline: .25 mg PO twice a week
The dose may be increased every 4 weeks as needed, up to 1 mg two times a week.
These drugs shrink the tumor and return prolactin levels to normal in approximately 80 percent of patients. Both drugs have been approved by the U.S. Food and Drug Administration for the treatment of hyperprolactinemia.
Prolactinoma and Pregnancy
A woman with a prolactinoma should discuss her plans to conceive with her physician, so she can be carefully evaluated prior to becoming pregnant. This evaluation will include
- A magnetic resonance imaging (MRI) scan to assess the size of the tumor
- An eye examination with measurement of visual fields
As soon as a patient is pregnant, she stop taking bromocriptine or cabergoline, the common treatments for prolactinoma. The patient should consult her endocrinologist promptly if she develops symptoms--particularly headaches, visual changes, nausea, vomiting, excessive thirst or urination, or extreme lethargy. Bromocriptine or cabergoline treatment may be renewed and additional treatment may be required if the patient develops symptoms from growth of the tumor during pregnancy.