Materiały źródłowe

• #1 Update in Pathogenesis, Diagnosis, and Therapy of Prolactinoma

  https://www.mdpi.com/2072-6694/14/15/3604

  Prolactinomas comprise 30–50% of all pituitary neuroendocrine tumors, frequently occur in females aged 20 to 50, and cause hypogonadism and infertility. In typical cases, female patients exhibit galactorrhea and amenorrhea due to serum prolactin (PRL) elevation, and patients during pregnancy should be carefully treated. During diagnosis, other causes of hyperprolactinemia must be excluded, and an MRI is useful for detecting pituitary neuroendocrine tumors. For treating prolactinoma, dopamine agonists (DAs) are effective for decreasing PRL levels and shrinking tumor size in most patients. Some DA-resistant cases and the molecular mechanisms of resistance to a DA are partially clarified. The side effects of a DA include cardiac valve alterations and impulse control disorders. Although surgical therapies are invasive, recent analysis shows that long-term remission rates are higher than from medical therapies. The treatments for giant or malignant prolactinomas are challenging, and the combination of medication, surgery, and radiation therapy should be considered.

• #2

  https://step1.medbullets.com/endocrine/109063/prolactinoma

  a prolactinoma is a non-cancerous pituitary tumor that overproduces the hormone prolactin […] treatment is usually with medication to restore a normal prolactin level or surgical resection […] Medical […] bromocriptine or cabergoline (dopamine agonists) […] first-line treatment […] dopamine suppresses prolactin secretion […] Surgical […] surgical resection […] patients who cannot tolerate or do not wish to take dopamine agonists […] patients who do not respond to medical treatment or show progression after an initial response to medical treatment.

• #3 Prolactinoma: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/124634-overview

  Prolactinomas can be assessed through hormone testing and magnetic resonance imaging (MRI) or computed tomography (CT) scanning. Bromocriptine (BEC) is generally considered to be the agent of choice in the treatment of prolactinomas. Surgically, transsphenoidal pituitary adenomectomy is the preferred treatment in patients with microprolactinomas and in most patients with macroprolactinomas. […] Treatment is indicated if mass effects from the pituitary tumor and/or significant effects from hyperprolactinemia are present. Bromocriptine (BEC) is generally considered to be the agent of choice in the treatment of prolactinomas because of its long track record and safety. As a dopamine (DA) agonist, it decreases the synthesis and secretion of PRL. It also decreases the rate of tumor cell division and the growth of individual cells.

• #4 Mayo Clinic Health Library – Prolactinoma | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20376943

  Prolactinoma is a noncancerous tumor of the pituitary gland. This tumor causes the pituitary gland to make too much of a hormone called prolactin. The major effect of a prolactinoma is decreased levels of some sex hormones namely, estrogen and testosterone. […] A prolactinoma can usually be treated with medications to bring the prolactin level down into the standard range and shrink the tumor. In some cases, surgery to remove the tumor might be an option. […] If you have a prolactinoma and you want to become or are already pregnant, talk to your health care provider. Adjustments in your treatment and monitoring may be necessary. […] Goals in the treatment of a prolactinoma include: Return the production of prolactin to within the standard range, Reduce the size of the prolactinoma, Restore healthy pituitary gland function.

• #5 Prolactinoma – Endocrine Surgery | UCLA Health

  https://www.uclahealth.org/medical-services/surgery/endocrine-surgery/patient-resources/patient-education/endocrine-surgery-encyclopedia/prolactinoma

  Prolactinoma is the most common type of pituitary adenoma and is also referred to as a prolactin-secreting adenoma of the pituitary. These tumors account for at least 30% of all pituitary adenomas. […] In women, the symptoms of infertility, irregular menstruation, loss of sexual interest, and milk flow not related to childbirth or nursing can be improved with treatment. Men should be treated when decreased sexual drive, infertility, or impotence occur. […] Bromocriptine, pergolide, and cabergoline are drugs that reduce prolactin levels in both men and women. Once started, these drugs must be continued for life. If the drug is stopped, the tumor will rapidly grow back. […] Surgery may be needed in the case of a prolactinoma that is not controlled by medication, and in patients who have trouble tolerating medication side effects. Radiotherapy (conventional radiation or gamma knife) is usually for patients who have persistent and progressive (worsening) prolactinoma after trying both medication and surgery.

• #6 Update in Pathogenesis, Diagnosis, and Therapy of Prolactinoma

  https://www.mdpi.com/2072-6694/14/15/3604

  The goals of prolactinoma treatment are to counteract hypogonadism by suppressing hyperprolactinemia and decreasing the size of the tumor. Pharmacotherapy is the first-line treatment for prolactinomas, and dopamine agonists (DAs) represent the primary therapy for almost all prolactinomas, including microtumors (less than 1 cm in diameter), macrotumors (greater than 1 cm), or giant tumors (greater than 4 cm). DAs, such as bromocriptine or cabergoline, are highly effective in suppressing PRL secretion and reducing tumor size. Long-acting DA (cabergoline) is often used in clinical practice because it is effective in small intermittent doses (0.25–0.5 mg once a week) without major side effects. […] DA resistance is defined as the inability to achieve a normalization of serum PRL levels and a 50% reduction in tumor size at least 3–6 months after the weekly administration of the maximum-tolerated dose of a DA: 15 mg of bromocriptine or 1.5–3.0 mg of cabergoline. If side effects make it difficult to increase the dose of a DA, a dose lower than this is the maximum. However, side effects of cabergoline were recorded in 68% of women, but only a few patients discontinued it.

• #7 Prolactinoma: Early Detection, Evaluation and Management – The ObG Project

  https://www.obgproject.com/2017/04/18/prolactinoma-early-detection-evaluation-and-management/

  Prolactinomas are generally benign prolactin-secreting tumors and account for 40-66% of all pituitary adenomas. The vast majority are microadenomas (diameter < 1cm) and suppress the hypothalamic-pituitary gonadal hormonal axis, while 10% are macroadenomas (≥ 1cm) and may cause additional mass effects due to size. [...] Despite their benign nature, if diagnosis is delayed bone loss and vertebral fractures can occur, and the loss of bone density can be permanent. [...] Clinical signs and symptoms: Oligo or amenorrhea, Galactorrhea and gynecomastia, Loss of libido and erectile dysfunction, Infertility, Decreased bone density, Mass effect: Headache, Visual field abnormalities. [...] Evaluation: Endocrine Society practice guideline recommends a single measurement of serum prolactin; a level above the upper limit of normal confirms the diagnosis as long as the serum sample was obtained without excessive venipuncture stress. [...] Most patients placed on dopamine agonists, Cabergoline > bromocriptine in reducing prolactin levels. Nearly 80% of patients treated with dopamine agonists will normalize prolactin level and reduce the size of their adenoma.

• #8 Prolactinomas | Pituitary Network Association – International non-profit organization for patients with pituitary tumors and disorders

  https://pituitary.org/disorders/prolactinomas/

  These pituitary tumors (also called adenomas) secrete excessive amounts of prolactin and are the most common type of pituitary tumor seen clinically. Prolactinomas generally have very different presentations in women and in men. In women, relatively small elevations in prolactin cause irregular menstrual periods or complete loss of menses (amenorrhea), ability to ovulate (remain fertile) and may cause milky discharge from the breasts (galactorrhea). In addition, women may have a reduction in their sex drive. The normal prolactin level is 20 ng/ml. In most women the tumors are detected when they are small (microadenomas) and the prolactin level is only moderately elevated (30 300 ng/ml). In contrast, in men prolactinomas are usually not detected until they are large (macroadenomas), most have prolactin levels over 500 ng/ml. Most men diagnosed with a prolactinoma have some degree of loss of sex hormone production. They may also have visual loss (from compression of the optic nerves or optic chiasm) and/or headache. A minority of patients with large tumors may have bleeding into the tumor (pituitary apoplexy) causing relatively sudden onset of headache, visual loss, double vision, and/or pituitary failure.

• #9

  https://www.healio.com/news/endocrinology/20240409/new-consensus-statement-addresses-advances-in-diagnosing-managing-prolactinomas

  The way endocrinologists manage prolactinomas is changing. […] A new international consensus statement from The Pituitary Society incorporates recent evidence on possible newly recognized adverse events associated with dopamine agonists, efficacy of transsphenoidal surgery and treatment of special populations, such as pregnant women and transgender adults. […] Prolactinoma prevalence is estimated at 40 cases per 100,000 adults for microprolactinomas and 10 cases per 100,000 adults for macroprolactinomas. […] The new consensus statement highlights changes in several aspects of prolactinoma management. One of those changes is that physicians may consider surgery as a first-line therapy in selected patients in lieu of dopamine agonists for microprolactinomas or enclosed prolactinomas. […] Changes in treatment recommendations have also occurred for special populations. The consensus statement includes specific recommendations for pregnant, perimenopausal and postmenopausal women and transgender adults.

• #10 Prolactinoma – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/prolactinoma/diagnosis-treatment/drc-20376962

  Goals in the treatment of a prolactinoma include: […] Prolactinoma treatment includes two main therapies: medications and surgery. […] Oral medications known as dopamine agonists are generally used to treat a prolactinoma. […] Dopamine agonists can decrease the production of prolactin and shrink the size of the tumor. […] Commonly prescribed drugs include cabergoline and bromocriptine (Cycloset, Parlodel). […] Surgery to remove a prolactinoma is generally an option if drug therapy doesn’t work or you can’t tolerate the drug. […] Surgery corrects the prolactin level in most people with small prolactinomas. However, tumors may come back within several years of surgery. […] Rarely, radiation therapy to kill tumor cells may be an option for a large prolactinoma.

• #11 Prolactinoma | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/prolactinoma

  A prolactinoma can usually be treated with medications to bring the prolactin level down into the standard range and shrink the tumor. In some cases, surgery to remove the tumor might be an option. […] If you have a prolactinoma and you want to become or are already pregnant, talk to your health care provider. Adjustments in your treatment and monitoring may be necessary. […] Goals in the treatment of a prolactinoma include: Return the production of prolactin to within the standard range, Reduce the size of the prolactinoma, Restore healthy pituitary gland function. […] For most people, treatment can eliminate or improve: Problems caused by increased prolactin levels, such as irregular menstrual periods, infertility and loss of interest in sexual activity, Signs or symptoms from tumor pressure, such as headaches or vision problems.

• #12 Medical Treatment for Prolactinoma | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/prolactinoma/treatments/medical-treatment.html

  The goal of treatment is to return prolactin secretion to normal, reduce tumor size, correct any visual abnormalities and restore normal pituitary function. […] Because dopamine is the chemical that normally inhibits prolactin secretion, doctors first treat a prolactinoma with dopamine agents (agonists). […] There are two dopamine agents that are often prescribed. […] Bromocriptine treatment should not be interrupted without consulting an endocrinologist. Prolactin levels often rise again in most people when the drug is discontinued. […] While medical treatment is often the first option for prolactinomas, in selected cases, surgical treatment might be a better choice than long-term medication because surgery is curative in a high percentage of cases.

• #13 Prolactinoma | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/prolactinoma

  Prolactinoma treatment includes two main therapies: medications and surgery. […] Oral medications known as dopamine agonists are generally used to treat a prolactinoma. These drugs mimic the effects of dopamine the brain chemical that controls how much prolactin is made. […] Both bromocriptine and cabergoline treat prolactinomas in people who want to become pregnant. […] Surgery to remove a prolactinoma is generally an option if drug therapy doesn’t work or you can’t tolerate the drug. […] Surgery corrects the prolactin level in most people with small prolactinomas. However, tumors may come back within several years of surgery. […] Rarely, radiation therapy to kill tumor cells may be an option for a large prolactinoma.

• #14 Elucidating Clinical Queries for Tailored Therapy in Patients with Prolactinoma

  https://www.e-enm.org/journal/view.php?number=2535

  Prolactinomas are the most prevalent type of pituitary neuroendocrine adenomas, primarily affecting women of reproductive age. Unlike other pituitary tumors, the first-line management has traditionally been pharmacological rather than surgical. This preference is due to the effectiveness of dopamine agonists (DAs), which typically reduce tumor size and normalize prolactin levels in most patients. […] The traditional management of prolactinomas has involved the use of dopamine agonists (DAs) as the first-line treatment. These medications effectively reduce tumor size and normalize prolactin levels in most patients. […] The intricate interplay between pharmacological treatment and reproductive health issues places endocrinologists at the forefront of managing these cases, emphasizing the necessity for specialized and comprehensive care for affected individuals.

• #15 Elucidating Clinical Queries for Tailored Therapy in Patients with Prolactinoma

  https://e-enm.org/journal/view.php?number=2535

  Prolactinomas are the most prevalent type of pituitary neuroendocrine adenomas, primarily affecting women of reproductive age. Unlike other pituitary tumors, the first-line management has traditionally been pharmacological rather than surgical. This preference is due to the effectiveness of dopamine agonists (DAs), which typically reduce tumor size and normalize prolactin levels in most patients. […] The traditional management of prolactinomas has involved the use of dopamine agonists (DAs) as the first-line treatment. These medications effectively reduce tumor size and normalize prolactin levels in most patients. […] Recent advances in surgical techniques and molecular biology have paved the way for the development of precision medicine, allowing for more flexible and personalized treatment strategies for prolactinomas.

• #16 Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-023-00886-5

  Patients with hyperprolactinaemia but serum levels of prolactin less than five times the upper limit of normal (ULN) should undergo repeat prolactin testing. […] Patients should be evaluated for associated clinical features, tested for pituitary hormone deficiencies and appropriately treated per standard guidelines. […] Surgical resection of prolactinomas can resolve hypopituitarism but can also cause new-onset deficiencies. […] Dopamine agonist therapy is highly effective at lowering serum levels of prolactin, improving clinical consequences of hyperprolactinaemia and reducing adenoma size. […] Cabergoline is the preferred dopamine agonist owing to its long half-life, high efficacy and good tolerability. […] Patients with prolactinoma of Knosp grade 2 should be treated with cabergoline.

• #17 Prolactinoma – NIDDK

  https://www.niddk.nih.gov/health-information/endocrine-diseases/prolactinoma

  A prolactinoma is a benign (noncancerous) tumor of the pituitary gland that produces a hormone called prolactin. […] In most cases, prolactinomas and related health problems can be successfully treated with medicines. […] Doctors commonly treat prolactinomas with medicines. More rarely, surgery or radiation therapy may be used. The goals of treatment are to bring prolactin levels back to normal, shrink the tumor, make sure the pituitary gland is working properly, and correct any problems caused by the tumor, such as menstrual problems, milky discharge from the breasts, low testosterone levels, headaches, or vision problems. […] Medicines called dopamine agonists control prolactin levels and shrink the tumor very effectively. […] Cabergoline is the preferred drug for treating prolactinomas, because it is more effective than bromocriptine and has fewer side effects.

• #18 Prolactinoma – Symptoms, Diagnosis, TreatmentSecond Opinion Iconphone iconSecond Opinion IconGroup 49

  https://www.barrowneuro.org/condition/prolactinoma/

  Prolactinomas are the most common type of hormone-producing pituitary tumors. Doctors can often treat them with prescription medicines alone. These medications, called cabergoline and bromocriptine, effectively lower prolactin levels and can, in most cases, shrink the tumor. In some exceptional cases, your care team may recommend surgery, radiation therapy, or both. […] Generally, the first line of treatment for prolactinoma is medical rather than surgical. Whichever treatment your medical team recommends, it will be important to regularly monitor your prolactin levels and the size of your prolactinoma. […] Prolactinomas are most often treated successfully with prescription medicines alone. […] Cabergoline is a dopamine receptor agonist. It works by inhibiting the cells that produce prolactin and the growth of abnormal prolactinoma cells. Cabergoline is the drug of choice for treating prolactinomas because it causes fewer and less severe side effects than bromocriptine.

• #19 Prolactinoma – Symptoms, Diagnosis, TreatmentSecond Opinion Iconphone iconSecond Opinion IconGroup 49

  https://www.barrowneuro.org/condition/prolactinoma/

  Bromocriptine blocks the production of prolactin by the pituitary gland and may cause your tumor to stop growing or shrink. This medicine is an option if treatment with cabergoline fails, if you don’t tolerate cabergoline, or if cabergoline is not advisable for other reasons. […] Neurosurgery is the appropriate treatment in the rare event your prolactinoma fails to respond to bromocriptine or cabergoline or if you don’t tolerate these medications. […] The surgery aims to minimize pain, discomfort, and trauma to the tissue surrounding your pituitary gland while maximizing your chance for a quick and uneventful recovery. Most prolactinoma patients can return home the day after their surgery. […] Gamma Knife radiosurgery is a highly advanced form of radiation therapy that can achieve results similar to those in the surgical techniques described above. […] Pituitary specialists usually reserve the Gamma Knife procedure for prolactinomas that are resistant to medical treatment in people who are not candidates for neurosurgery for reasons like age or other medical conditions.

• #20 Prolactinoma Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/124634-treatment

  Treatment is indicated if mass effects from the tumor and/or significant effects from hyperprolactinemia are present. […] Any patient with macroprolactinoma needs treatment, because the tumor has already shown a propensity to grow. Such treatment includes the following: […] Bromocriptine (BEC) is generally considered to be the agent of choice in the treatment of prolactinomas because of its long track record and safety. […] Common adverse effects include nausea, nasal stuffiness, and dizziness associated with orthostatic hypotension. […] Normalization of PRL levels occurs in 85-90% of all patients with prolactinomas. […] In microprolactinomas, PRL levels return to normal within days to a few weeks of starting treatment in almost all patients who can tolerate appropriate doses of BEC.

• #21 Prolactinoma Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/124634-treatment

  In macroprolactinomas, BEC treatment results in some reduction of tumor size in up to 80-85% of the patients. […] Once normalization of PRL levels is achieved and sustained, the dose of BEC is gradually tapered to approximately 2.5 mg/d. […] Other medical treatments are available for prolactinoma patients who do not respond to BEC or for those who cannot tolerate the drug. […] A study of patients with prolactinoma demonstrated that attempting DA agonist withdrawal in patients who have been treated for 2 years is practical and safe if normalization of prolactin levels and evidence of tumor reduction are observed. […] In those patients with DARPs having persistent hyperprolactinemia despite surgical debulking, with or without radiotherapy, temozolomide, a chemotherapeutic alkylating agent, has been recommended.

• #22 Prolactinomas | Pituitary Network Association – International non-profit organization for patients with pituitary tumors and disorders

  https://pituitary.org/disorders/prolactinomas/

  In general, the first line of treatment for patients with a prolactinoma is medical rather than surgical. Approximately 80% of patients will have their prolactin levels restored to normal with dopamine agonist therapy. The most commonly used agents are bromocriptine (Parlodel) or cabergoline (Dostinex). Most women also have a return of menses and many become fertile again. The size of the prolactinoma will be reduced in the majority of patients to varying degrees, which often results in improved vision and resolution of headaches. […] For larger tumors, the surgical cure rate is generally considerably less. In men with large invasive prolactinomas, it is particularly low, averaging less than 30%. For this reason, dopamine agonist therapy is usually tried first. In patients who present with loss of vision, dopamine agonist therapy is also usually indicated first unless the visual loss has occurred relatively suddenly over a period of one to two weeks or less. For the minority of patients that do not respond well to cabergoline or bromocriptine, surgery should generally be performed within 6 months of starting dopamine agonist therapy. After more than six months of such therapy the tumor may become more fibrotic and more difficult to remove.

• #23 Prolactinoma: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22007-prolactinoma

  Prolactinomas are often highly treatable. Healthcare providers usually prescribe medication to treat them. In rare cases, your provider may recommend surgery or radiation therapy. […] Medications called dopamine agonists are often very effective in shrinking prolactinoma tumors. They can also return your prolactin level to a healthy range. […] Common side effects of dopamine agonists include nausea, vomiting and dizziness. […] You’ll likely have to take either of these medications for at least two years to prevent the tumor from growing back, especially if it’s large. After two years, your provider may slowly reduce your dosage and then stop the medication if your prolactin levels are normal and the tumor is no longer visible. […] Although it’s rare, you may need to have surgery to treat prolactinoma for any of the following reasons: You’re having negative reactions to dopamine agonists.

• #24 Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-023-00886-5

  Patients with resistance or intolerability to other dopamine agonist therapy should be switched to cabergoline. […] Patients should be advised before starting treatment about frequent, mild adverse effects of cabergoline, including gastrointestinal symptoms, dizziness and fatigue. […] Patients should be informed about the potential for the rare adverse effect of cardiac valve changes with long-term and/or high-dose cabergoline treatment. […] Surgical resection of microprolactinomas and well-circumscribed macroprolactinomas (Knosp grade 0 and 1) by an experienced neurosurgeon offers a high chance of cure, is cost-effective and avoids long-term dopamine agonist treatment. […] Management of prolactinoma in patients with an underlying psychiatric disorder requires collaboration between the endocrinologist, neurosurgeon and psychiatrist.

• #25

  https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2024/08000/prolactinoma__navigating_the_dual_challenge_of.48.aspx

  Prolactinoma is the most common secretory tumour of the pituitary gland, accounting for up to 40% of all pituitary adenomas. […] Pharmacological therapy is effective in most prolactinomas, and the mainstay of care typically consists of dopamine agonists, Cabergoline being the most commonly used drug to regulate prolactin levels and reduce tumour mass. […] Prolactinoma, a benign tumour of the pituitary gland causing elevated levels of prolactin, is associated with a spectrum of side effects ranging from reproductive and menstrual disturbances to neurological and psychological manifestations. […] This study delves into the distinctive adverse effects of prolactinomas on both men and women. […] While dopamine agonists are effective, they are associated with various side effects. Common side effects include nausea, dizziness, headache, and gastrointestinal disturbances.

• #26

  https://www.healio.com/news/endocrinology/20240409/new-consensus-statement-addresses-advances-in-diagnosing-managing-prolactinomas

  The consensus statement offers a step-by-step approach for diagnosing prolactinomas. […] Fleseriu said physicians should measure prolactin if adults are exhibiting any features of excess levels, including an absence of menses, low libido, low sexual function or galactorrhea. […] The most common first-line treatment for prolactinomas is dopamine agonist therapy. According to the consensus statement, cabergoline is the preferred choice of therapy due to its long half-life, high efficacy and good tolerability. […] Men seem to be at higher risk for impulse control disorders, Cooper said. It is critical to counsel patients and their families on these potential behaviors and to consider baseline questionnaires for impulse control behaviors. […] One of the biggest changes with prolactinoma treatment in recent years is a choice of medication or surgery as first-line therapy.

• #27 Prolactinoma: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000336.htm

  A prolactinoma is a noncancerous (benign) pituitary tumor that produces a hormone called prolactin. This results in too much prolactin in the blood. […] Medicine is usually successful in treating prolactinoma. Some people have to take these medicines for life. Other people can stop taking the medicines after 2 to 3 years, especially if their tumor was small (less than 1 cm) when it was discovered or has disappeared from the MRI images. But there is a risk that the tumor may grow and produce prolactin again, especially if it was a large tumor. […] Surgery may be done for any of the following: Symptoms are severe, such as a sudden worsening of vision; You are not able to tolerate the medicines to treat the tumor; The tumor does not respond to medicines. […] The outlook is usually excellent but depends on the success of medical treatment or surgery. Getting tested to check whether the tumor has returned after treatment is important.

• #28 Patient education: High prolactin levels and prolactinomas (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/high-prolactin-levels-and-prolactinomas-beyond-the-basics/print

  If the prolactin level decreases to normal or near-normal levels, the symptoms caused by the elevated prolactin are reversed. […] If the prolactin level remains normal and no tumor is seen on magnetic resonance imaging (MRI) for two or more years, a trial period without medication can be considered. […] Surgery is an option when dopamine agonists are ineffective or not tolerated. […] Surgery can often reduce the blood prolactin concentration, sometimes to normal. […] Radiation therapy can shrink prolactinomas and lower blood prolactin levels, but these effects usually take several years.

• #29 Elucidating Clinical Queries for Tailored Therapy in Patients with Prolactinoma

  https://www.e-enm.org/journal/view.php?number=2535

  Although DAs are highly effective in treating prolactinoma, the optimal timing for discontinuing DA therapy remains controversial. […] A previous meta-analysis showed that withdrawal of DAs was associated with persisting normal prolactin levels in only 21% of patients with microprolactinomas and 16% of those with macroprolactinomas. […] DAs have been recommended as the first-line treatment for prolactinoma because of their effectiveness in normalizing serum prolactin levels and reducing tumor size. […] Given these potential complications, there is growing interest in the effectiveness and safety of TSA as an alternative primary treatment. […] This review highlights the heterogeneity in patient responses, indicating that some patients exhibit resistance to DAs and may benefit from surgical resection as a first-line treatment. […] By integrating these approaches, clinicians can enhance the precision and efficacy of prolactinoma management, ultimately improving patient outcomes and quality of life.

• #30 Elucidating Clinical Queries for Tailored Therapy in Patients with Prolactinoma

  https://e-enm.org/journal/view.php?number=2535

  Once pregnancy is confirmed, DA treatments are promptly discontinued in patients with a microadenoma or non-compressive macroprolactinoma, and these patients are then monitored clinically through regular office visits with an endocrinologist. […] Surgical debulking in the second trimester or delivery (if the pregnancy is sufficiently advanced) may be considered if there is no response to DA, although this is rarely necessary. […] Breastfeeding in women with prolactinomas is generally considered safe. […] Although DAs are highly effective in treating prolactinoma, the optimal timing for discontinuing DA therapy remains controversial. […] A trial of DA tapering and withdrawal may be considered for patients who meet the following criteria: (1) achievement of normal prolactin levels post-therapy; (2) completion of a 3-year period of DA treatment; and (3) significant reduction in tumor volume.

• #31 Patient education: High prolactin levels and prolactinomas (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/high-prolactin-levels-and-prolactinomas-beyond-the-basics

  Surgery is an option when dopamine agonists are ineffective or not tolerated. Surgery may also be the best choice for a female with very large macroadenoma that is not entirely responsive to dopamine agonists who wants to become pregnant. […] Surgery can often reduce the blood prolactin concentration, sometimes to normal. This is more likely for a microadenoma than a macroadenoma. […] Radiation therapy can shrink prolactinomas and lower blood prolactin levels, but these effects usually take several years. Therefore, radiation is uncommonly used as treatment of macroadenomas, and when it is, it is used to prevent regrowth of substantial residual tissue that could not be removed during surgery of a macroadenoma that is not responsive to dopamine agonists.

• #32 Prolactinoma Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/124634-treatment

  Radiation treatment (XRT) has had a less prominent role in the treatment of prolactinomas. […] The treatment of pregnant women with prolactinomas must be tailored to the individual patient. […] Transsphenoidal pituitary adenomectomy is the preferred surgical treatment in patients with microprolactinomas and in most patients with macroprolactinomas. […] A combination of surgery followed by postoperative medical treatment with BEC or one of the other agents is used in patients with incomplete resolution of elevated PRL levels and in persons with residual tumors seen on follow-up imaging studies. […] In patients with macroprolactinomas, normalization of the PRL level occurs initially in approximately 30% of patients, and the recurrence rate is about 15-20%. […] Indications for surgery are as follows: Women who have a microadenoma, desire pregnancy, and cannot tolerate BEC should undergo surgical treatment. […] A retrospective study of male patients by Andereggen et al indicated that in men with prolactinomas, impaired bone density remains a problem even after medical (DA agonist) or surgical treatment.

• #33 Prolactinoma: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/124634-overview

  Transsphenoidal pituitary adenomectomy is the preferred surgical treatment in patients with microprolactinomas and in most patients with macroprolactinomas. A combination of surgery followed by postoperative medical treatment with BEC or one of the other agents is used in patients with incomplete resolution of elevated PRL levels and in persons with residual tumors seen on follow-up imaging studies.

• #34 Prolactinoma | Brain Institute | OHSU

  https://www.ohsu.edu/brain-institute/prolactinoma

  If you need surgery, it’s important to see a highly experienced neurosurgeon such as the ones at OHSU. Removing a prolactinoma is complex. Our surgeons do more than 100 tumor surgeries in and around the pituitary gland each year. This high level of experience improves the chances of success. […] Prolactinomas can come back within five years. We will monitor you, especially if you had a large prolactinoma. Our research shows that these tumors can be especially aggressive in men. […] If you are pregnant and have a prolactinoma, your doctor will monitor you carefully to see if the tumor grows. You will need regular vision tests, because prolactinomas often develop close to an optic nerve connecting an eye to the brain. […] We are a national leader in offering clinical trials to test promising new approaches. Your care team will talk with you about any trial that is right for you.

• #35 Update in Pathogenesis, Diagnosis, and Therapy of Prolactinoma

  https://www.mdpi.com/2072-6694/14/15/3604

  Most surgeries for prolactinomas are performed by transsphenoidal surgery, and endoscopic transsphenoidal surgery is currently the mainstream method. A craniotomy is required depending on the location of the tumor. […] The common indications for surgery in prolactinomas are resistance or intolerance to DA or the failure of the maximum dose of DA to lower the PRL or reduce tumor volume in macroprolactinomas. […] The aims of radiation therapy for prolactinomas are (1) to inhibit the growth of the tumor, (2) suppress hormone secretion, and (3) suppress the further progression of the tumor remnants that pathologically indicate aggressive behavior through adjuvant therapy.

• #36 Prolactinoma – NIDDK

  https://www.niddk.nih.gov/health-information/endocrine-diseases/prolactinoma

  For most small prolactinomas, dopamine agonists bring prolactin levels back to normal and shrink tumors in 4 out of 5 patients. […] Although doctors most often treat prolactinomas with medicines, in some cases surgery may be an option. […] When done by an experienced surgeon, the surgery corrects prolactin levels in about 90 percent of people with small tumors and 50 percent of those with large tumors. […] More rarely, if medicines and surgery fail to reduce prolactin levels, radiation therapy may be used. […] Having a prolactinoma may make it difficult for you to become pregnant, but treatment with dopamine agonists is very effective in restoring fertility. […] As soon as your pregnancy is confirmed, your doctor will usually advise you to stop taking these medicines to prevent any possible effects on the fetus. […] After delivery, women with small prolactinomas can usually nurse their babies.

• #37 Elucidating Clinical Queries for Tailored Therapy in Patients with Prolactinoma

  https://e-enm.org/journal/view.php?number=2535

  DAs have been recommended as the first-line treatment for prolactinoma because of their effectiveness in normalizing serum prolactin levels and reducing tumor size. […] However, the side effects associated with these medications, coupled with the need for prolonged therapy in most patients, have prompted a reconsideration of transsphenoidal adenomectomy (TSA) as a viable primary treatment option. […] Given these potential complications, there is growing interest in the effectiveness and safety of TSA as an alternative primary treatment. […] While DAs remain the first-line treatment for prolactinomas, the notable advancements in TSA techniques and the high success rates in surgical outcomes indicate that TSA could be a viable first-line treatment option for certain patients. […] Identifying clinical, pathological, and molecular factors is crucial for pinpointing patients with aggressive lactotroph tumors, enabling intensive therapy and rigorous long-term follow-up. […] The variability in treatment response underscores the need for personalized therapeutic approaches.

• #38 Prolactinoma: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22007-prolactinoma

  Together, you and your healthcare provider will decide if surgery is the best option for you. […] As with all surgeries, there are possible complications and risks associated with prolactinoma surgery. Your provider will go over these risks with you. […] Radiation therapy is a rare third option for treating prolactinomas if medications and/or surgery don’t work to reduce your prolactin levels. Depending on the size and location of the tumor, you may receive one radiation dose or multiple doses over several weeks. […] If you’re taking medication to treat prolactinoma, you’ll likely be on it for a long time typically, at least two years. If you’re taking medication, you’ll likely need to see your healthcare provider regularly to monitor the tumor and your prolactin levels. […] The good news is that prolactinomas are almost always benign (noncancerous) and highly treatable usually with medication.

• #39 Prolactinomas | Pituitary Network Association – International non-profit organization for patients with pituitary tumors and disorders

  https://pituitary.org/disorders/prolactinomas/

  Because most patients with prolactinomas respond well to dopamine agonist therapy, radiation is indicated in only an occasional patient. Stereotactic radiation is generally preferred over external beam radiation therapy because a higher dose of radiation can be delivered to the tumor with less radiation being given to normal brain structures.

• #40 Managing Your Prolactinoma – Symptoms & Treatment | Carle.org

  https://carle.org/conditions/prolactinoma

  The best treatment depends on symptoms and tumor size. The treatment goal is to have normal reproductive and pituitary function and minimize symptoms, such as production of breast milk and changes in periods. […] People with symptoms need medicine (e.g., bromocriptine and cabergoline) to shrink the tumor and reduce prolactin levels. […] DO make sure that your prolactin level was measured after an 8-hour fast, and that there was no recent breast stimulation, to get an accurate prolactin level. […] DO find an experienced surgeon if you need surgery. A neurosurgeon (health care provider who specializes in surgery for the nervous system) should do the operation. Success depends on the neurosurgeons experience and skill. […] DO call your health care provider if you have vision changes or an unusual increase in headaches. […] DO call your health care provider if you have nausea or dizziness from the medicine. […] DO call your health care provider if you feel extremely weak and tired or urinate often after surgery.

• #41 Prolactinoma – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/prolactinoma/symptoms-causes/syc-20376958

  Prolactinoma can usually be treated with medications to bring the prolactin level down into the standard range and shrink the tumor. In some cases, surgery to remove the tumor might be an option. […] If you have a prolactinoma and you want to become or are already pregnant, talk to your health care provider. Adjustments in your treatment and monitoring may be necessary. […] Complications of prolactinoma may include: Infertility. A prolactinoma can interfere with reproduction. Too much prolactin reduces the production of the hormones estrogen and testosterone. […] Left untreated, a prolactinoma may grow large enough to press on your optic nerve. This nerve sits near the pituitary gland. The nerve sends images from your eye to your brain so that you can see. The first sign of pressure on the optic nerve is a loss of your side (peripheral) vision.

• #42 Prolactinoma Management – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279174/

  For that reason, children and adolescents with pituitary adenomas, including prolactinomas, should be treated by a pituitary specific multidisciplinary team. […] Medical treatment with a dopamine agonist is first line treatment in children and adolescents with prolactinomas. […] Neurosurgical intervention should be considered if vision deteriorates or does not improve on medical therapy or if dopamine agonist resistance, escape or intolerance occurs.

• #43 Prolactinoma & Hyperprolactinemia | Symptoms, Treatment | MedStar Health

  https://www.medstarhealth.org/services/hyperprolactinemia-prolactinoma

  Achieving the best outcome from hyperprolactinemia treatment requires a comprehensive, multidisciplinary approach that involves a highly skilled team of experts. […] The pituitary center at MedStar Washington allows patients to schedule office visits, diagnostic testing, and surgery with a team of neurosurgeons experienced with pituitary disorders, a pituitary endocrinologist, a neuro ophthalmologist, and an otolaryngologist all in the same location. […] If surgical intervention is required, prognosis typically depends on the size and location of the tumor. […] For this reason, it is extremely important to schedule and attend all follow-up appointments recommended by the physician in order to monitor for prolactinoma recurrence.

• #44 Prolactinoma – Pituitary & Skull Base Tumor | UCLA Health

  https://www.uclahealth.org/medical-services/neurosurgery/pituitary-skull-base-tumor/conditions/pituitary-adenomas/prolactinoma

  A prolactinoma is a type of pituitary tumor (adenoma) that produces an excessive amount of the hormone prolactin. Prolactinomas are the most common type of hormonally-active pituitary tumor. […] Our comprehensive approach to diagnosis and treatment of pituitary adenomas and conditions, including prolactinoma, sets the UCLA Pituitary Tumor Program apart. Our physicians treat a high volume of patients every year and perform over 100 pituitary surgeries a year, making us one of the top programs in the United States. We use the most sophisticated diagnostic equipment and offer minimally invasive surgical procedures. […] Medication is the first line of treatment for a prolactinoma. Your doctor will prescribe a medication that mimics the effects of dopamine, the brain chemical that normally inhibits the release of prolactin by the pituitary gland. The two most commonly prescribed medications are: Cabergoline (trade name: Dostinex) is usually the preferred medication because it is effective, has the fewest side effects and has an easy-to-manage dosage schedule of twice per week.

• #45 Prolactinoma | Brain Institute | OHSU

  https://www.ohsu.edu/brain-institute/prolactinoma

  Dr. Elena Varlamov is a neuroendocrinologist and an expert in pituitary disease. She is part of our large team to care for patients with prolactinomas. […] A prolactinoma is a type of pituitary gland tumor that requires care from pituitary specialists. At the OHSU Pituitary Center, you will find: A team of pituitary experts who work will together to care for you. The expertise to give you a precise diagnosis and a care plan tailored to your needs. A high-volume center that treats more than 1,500 patients with pituitary conditions a year. Skilled neurosurgeons who use minimally invasive techniques for an easier recovery. Close follow-up care for large prolactinomas, based on our own research. Access to clinical trials testing the latest approaches to treatment. […] Medication returns prolactin levels to normal for about 80% of patients with a prolactinoma. Some patients benefit from surgery.

• #46 Prolactinoma: Early Detection, Evaluation and Management – The ObG Project

  https://www.obgproject.com/2017/04/18/prolactinoma-early-detection-evaluation-and-management/

  Transsphenoidal surgery can result in normal prolactin levels in majority of microadenomas and up to 40% in macroadenomas. […] Follow Up: Once prolactin levels have improved monitoring is recommended with repeat prolactin levels every 3 to 6 months for the first year and then every 6 to 12 months thereafter. […] The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours. […] Early detection, monitoring and a management plan, which may be multidisciplinary, is required for good outcomes.

• #47 Prolactinoma | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/prolactinoma

  Prolactinomas are treated with medications called dopamine agonists, which reduce the secretion of prolactin and, in many cases, shrink the size of the tumor. […] Periodic follow-up is required to check the status of the tumor, including imaging and checking levels of prolactin. […] If dopamine agonists are taken to control prolactin levels and shrink the tumor, the medication might be needed for life. In some cases, if the medication is stopped, the prolactin level may rise back to abnormal levels and the tumor may increase in size. In other cases, judiciously reducing medications may be an option.

• #48 Elucidating Clinical Queries for Tailored Therapy in Patients with Prolactinoma

  https://e-enm.org/journal/view.php?number=2535

  This review aims to enhance clinical decision-making and patient care for endocrinologists by focusing on several key factors: predictive markers of DA sensitivity, clinical characteristics and suitability for transsphenoidal adenomectomy as a potential first-line treatment, factors determining the successful withdrawal of DAs after prolonged use, safety concerns during pre/post-pregnancy and breastfeeding, and determinants of tumor aggressiveness. […] DA treatment restores ovulation in over 90% of women with amenorrhea and anovulation due to prolactinomas. […] When selecting a DA for women who wish to become pregnant, BRC has traditionally been the preferred choice due to its shorter half-life and the extensive data supporting its use compared to CAB. […] It is generally recommended that a patient wait for multiple menstrual cycles to take place before attempting to conceive after initiating DA treatment, as this enables better monitoring of missed menstrual cycles.

• #49 Diagnosis and Management of Galactorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0801/p543.html

  An algorithm for managing women with prolactinoma is presented in Figure 1. […] Patients with isolated galactorrhea and normal prolactin levels do not require treatment if they are not bothered by the galactorrhea, do not wish to conceive, and do not show evidence of hypogonadism or reduced bone density. […] In patients with hyperprolactinemia, prolactin levels should be monitored, and MRI should be performed every two years. […] Treatment goals include suppressing prolactin secretion and its clinical and biochemical consequences, reducing the size of the prolactinoma, and preventing its progression or recurrence. […] Dopamine agonists are the preferred treatment for most patients with hyperprolactinemic disorders; these agents are extremely effective in lowering serum prolactin levels, eliminating galactorrhea, restoring gonadal function, and decreasing tumor size.

• #50

  https://www.healio.com/news/endocrinology/20240409/new-consensus-statement-addresses-advances-in-diagnosing-managing-prolactinomas

  The statement said surgery by an experienced neurosurgeon offers a high chance of cure, is cost-effective and avoids long-term dopamine agonist treatment. […] According to the statement, pregnancy is considered a risk factor for prolactinoma enlargement, and the risk is higher for women who have not had prior surgery. […] For women with large microadenomas, or small macroadenomas, if they did not need dopamine agonists during pregnancy, we usually perform an MRI to establish a baseline and restart dopamine agonists if there is no desire for lactation. […] For women with a macroprolactinoma, treatment should be focused on controlled adenoma growth rather than prolactin level. […] Further research is required to develop better algorithms to inform the patient about the most effective treatment approach for their specific situation.

• #51 Prolactinomas Tumors in Women – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/neurology/womens-neurology-program/prolactinomas

  One of the main roles of prolactin is to stimulate breast milk production, thus circulating prolactin levels in a woman are quite high when she is breast feeding. In most cases, women with prolactinomas will continue to remain off of their medications while they breastfeed. […] Women with prolactinomas are treated with prolactin lowering medications because high prolactin levels disrupt the normal cycles and causes amenorrhea, or a loss of periods. Once a woman goes through menopause and is no longer having regular periods these prolactin lowering medications can sometimes be stopped.

• #52 Prolactinoma – Endocrine Surgery | UCLA Health

  https://www.uclahealth.org/medical-services/surgery/endocrine-surgery/patient-resources/patient-education/endocrine-surgery-encyclopedia/prolactinoma

  The outlook depends heavily on the success of medical and surgical therapies. Tests to scan for recurrence following treatment are important. […] Tumor regrowth is the main complication. If untreated, tumor growth may result in permanent vision loss, including blindness, because large tumors in this area often press on the nerves involved in vision. […] See your health care provider if symptoms suggestive of prolactinoma develop. If you have had a prolactinoma in the past, call your health care provider if you experience recurrence of the symptoms.

• #53 Prolactinoma: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000336.htm

  Women with prolactinomas should be followed closely during pregnancy. They should discuss this tumor with their provider before taking birth control pills with a higher than usual estrogen content. […] See your provider if you have any symptoms of prolactinoma. If you have had a prolactinoma in the past, contact your provider for a general follow-up, or if your symptoms return.

• #54 Prolactinoma: Diagnosis and Treatment – My Endo Consult

  https://myendoconsult.com/learn/prolactinoma-diagnosis-and-treatment/

  Dopaminergic agonists are the first line for treatment of prolactinomas. […] Either bromocriptine or cabergoline can be used as treatments. […] If hyperprolactinemia suppresses gonadotrophin production, gonadotrophin axis recovery after DA therapy can occur so long as gonadotrophs aren’t affected by mass effect from prolactin secreting tumor. […] If gonadotrophs are profoundly affected by the mass effect of a prolactin secreting tumor, treatment with estrogen or testosterone might be necessary, as their function may not be restored after normalising prolactin levels. […] Side effects of DA include nausea, vomiting, headaches, postural hypotension, psychotropic side effects (hallucinations, psychosis) and nasal congestion. […] It is reasonable to screen for psychiatric disorders before initiating dopaminergic agonists.

• #55 Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-023-00886-5

  Most participants agreed that evaluation for restoration of gonadal function should be performed at least 6 months after normalization of prolactin serum levels. […] Normalization of serum prolactin levels occurs in 45% of untreated women with microprolactinoma entering menopause. […] Hyperprolactinaemia related to feminizing hormone treatment occurs in up to 20% of transwomen and is usually mild and asymptomatic. […] Serum levels of prolactin are elevated in patients with CKD. […] In most patients, dopamine agonists are highly effective at normalizing serum levels of prolactin and shrinking prolactinomas.

• #56 Prolactinoma: Diagnosis and Treatment – My Endo Consult

  https://myendoconsult.com/learn/prolactinoma-diagnosis-and-treatment/

  Dopaminergic agonist-resistant prolactinomas are usually treated with surgical debulking, radiation therapy, or temozolomide. […] There are reports of prolactinomas that have responded to pasireotide. […] TMZ promotes the methylation of guanine(G) at the number 6 carbon position, a step that leads to the formation of methylguanine residues in DNA. […] TMZ, a chemotherapeutic agent, is associated with expected short-term toxicity concerns, such as nausea, emesis, and fatigue. […] Safety data after 5 to 8 years of exposure to TMZ are very reassuring, making it a valuable long-term salvage therapeutic option.

• #57

  https://link.springer.com/article/10.1007/s11102-023-01346-z

  To describe care trajectories in patients with prolactinoma, aiming to clarify the rationale for surgery. […] Care trajectories were highly individualized based on patient and tumor characteristics, as well as the multidisciplinary teams assessment (need for alternative treatment, surgical chances and risks). […] Most patients were pretreated pharmacologically and had broad variation in timing of referral, undergoing surgery as last-resort treatment predominantly due to DA intolerance. […] High quality imaging and multidisciplinary consultations with experienced neurosurgeons and endocrinologists enabling treatment tailored to patients needs were prerequisites for adequate counseling in treatment of patients with prolactinoma. […] The need for surgery was high in all patients, as discussed during the preoperative MDT meetings.

• #58 Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-023-00886-5

  This Consensus Statement from an international, multidisciplinary workshop sponsored by the Pituitary Society offers evidence-based graded consensus recommendations and key summary points for clinical practice on the diagnosis and management of prolactinomas. […] In-depth discussions present the latest evidence on treatment of prolactinoma, including efficacy, adverse effects and options for withdrawal of dopamine agonist therapy, as well as indications for surgery, preoperative medical therapy and radiation therapy. […] Management of prolactinoma in special situations is discussed, including cystic lesions, mixed growth hormone-secreting and prolactin-secreting adenomas and giant and aggressive prolactinomas. […] The workshop concluded that, although treatment resistance is rare, there is a need for additional therapeutic options to address clinical challenges in treating these patients and a need to facilitate international registries to enable risk stratification and optimization of therapeutic strategies.

• #59 Prolactinoma: Symptoms, Diagnosis and Treatment

  https://patient.info/hormones/prolactinoma

  The main complication is the risk of 'thinning’ of the bones (osteoporosis), which occurs if high prolactin levels are untreated for a long time (over one year). Osteoporosis can be prevented by treating the prolactinoma (as above). […] The outlook (prognosis) for most people with a prolactinoma is very good. Most prolactinomas are successfully treated with medication. If this does not work, surgery is usually successful.

• #60 Prolactinoma: Symptoms, Surgery, Treatment

  https://www.medicinenet.com/prolactinoma/article.htm

  Prolactinomas are usually initially treated with medications. […] Surgery is considered if the medications cannot be tolerated, or if they are not effective. […] The medical treatment may be only partially successful. In such cases, the medications may be combined with surgery or radiation therapy. […] Because dopamine is the chemical in the brain that normally inhibits prolactin secretion, doctors may treat prolactinomas with drugs that act like dopamine such as bromocriptine or cabergoline. […] Both bromocriptine and cabergoline have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of hyperprolactinemia (high blood prolactin levels). […] Treatment with these drugs is successful in shrinking the tumor and returning prolactin levels to normal in approximately 80% of cases, or four out of every five patients.

• #61 Prolactinoma Management – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279174/

  Prolactinomas comprise nearly 40% of all pituitary tumors. Patients with prolactinomas usually come to medical attention as a result of symptoms caused by elevated prolactin levels, such as hypogonadism, menstrual irregularities, infertility or galactorrhea, or due to mass effects. […] A dopamine agonist is the treatment of choice in the vast majority of cases. Dopamine agonists can normalize prolactin levels, restore the function of the gonadal axis, stop galactorrhea, and significantly decrease tumor size in most of the patients, with cabergoline generally being more efficacious and better tolerated than bromocriptine. […] Transsphenoidal surgery is an alternative treatment in cases of dopamine agonist resistance or intolerance. Radiation therapy is reserved for those rare patients with macroadenomas not responding to either medical or surgical treatment.

• #62 Maci’s story: Managing life and prolactinoma – Pituitary Foundation

  https://www.pituitary.org.uk/information/macis-story-managing-life-and-prolactinoma/

  I became established with an endocrinologist within two weeks and began cabergoline. Due to medication side effects and prioritizing my overall health, I began working less night shifts. I had appointments for regular bloodwork, medication check-ins, repeat brain scans, and vision tests in between other commitments. This was my new normal. […] It is as if she read my mind when she proceeded to explain next steps. I was to see a local endocrinologist soon, and likely begin medication to help lower prolactin levels, and work on shrinking the tumour. […] I am happy to report shrinkage, and lower prolactin levels since beginning Cabergoline treatment. Had I not gone to my appointment that day, and allowed more time for tumor growth, I may have had a different story to tell. […] This diagnosis has led me to choose gratitude along the way. Gratitude for how quickly my primary care provider acted in this scenario. For how competent her and other members of my healthcare team have been. For the treatment options that I have. For the ability to truly exercise my faith and place this situation in bigger hands. For my support system. For others who share in diagnosis or have a similar story. For my life and my health.

Zobacz więcej