Materiały źródłowe

• #1 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.

• #2 Prolactinoma – NIDDK

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

  Having too much prolactin in the blood, a condition called hyperprolactinemia, can cause infertility and other problems. 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.

• #3 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. […] The two dopamine agonists that healthcare providers prescribe to treat prolactinomas are cabergoline and bromocriptine. Cabergoline is often the first-choice medication because its more effective than bromocriptine and has fewer side effects. […] Although its rare, you may need to have surgery to treat prolactinoma for any of the following reasons: You’re having negative reactions to dopamine agonists. The dopamine agonists aren’t working to shrink the tumor. You take antipsychotic medications that interact with dopamine agonists. You have a large prolactinoma and want to surgically remove it before trying to become pregnant.

• #4 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. Surgeons use two types of surgeries to remove prolactinomas, including: Transsphenoidal surgery: This is the most common surgery for prolactinomas. A surgeon makes an incision (small cut) at the back of your nasal cavity or under your upper lip to access your pituitary gland and the tumor. Transcranial surgery: For this surgery, a surgeon removes the tumor through an opening in your skull. They typically only use this type of surgery if the tumor is very large. […] 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.

• #5 Prolactinoma – NIDDK

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

  Having too much prolactin in the blood, a condition called hyperprolactinemia, can cause infertility and other problems. 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.

• #6 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

  Dopamine agonist therapy is highly effective at lowering serum levels of prolactin, improving clinical consequences of hyperprolactinaemia and reducing adenoma size (strong). […] Cabergoline is the preferred dopamine agonist owing to its long half-life, high efficacy and good tolerability (strong). […] Cabergoline is used as primary medical therapy in patients with prolactinoma. For microprolactinomas and well-encased macroprolactinomas (Knosp grade 0 and 1), the curative potential and risks of surgery should be discussed with patients in a multidisciplinary setting prior to medical treatment initiation (strong). […] Patients with prolactinoma of Knosp grade 2 should be treated with cabergoline (strong). […] Patients with resistance or intolerability to other dopamine agonist therapy should be switched to cabergoline (strong).

• #7 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. […] The two dopamine agonists that healthcare providers prescribe to treat prolactinomas are cabergoline and bromocriptine. Cabergoline is often the first-choice medication because its more effective than bromocriptine and has fewer side effects. […] Although its rare, you may need to have surgery to treat prolactinoma for any of the following reasons: You’re having negative reactions to dopamine agonists. The dopamine agonists aren’t working to shrink the tumor. You take antipsychotic medications that interact with dopamine agonists. You have a large prolactinoma and want to surgically remove it before trying to become pregnant.

• #8 Prolactinoma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459347/

  Prolactinomas can lead to a wide variety of symptoms, either due to mass effect or hypersecretion of prolactin. […] This activity illustrates the evaluation, treatment, and complications of prolactinomas and the importance of an interprofessional team approach to its management. […] Review the management of prolactinomas. […] Explain the role of collaboration among interprofessional team members to improve care coordination and minimize oversight, leading to earlier diagnosis and treatment and better outcomes for patients with prolactinomas. […] Macroprolactinoma or symptomatic microadenoma should be treated with dopamine agonist therapy. The goals of treatment would be tumor shrinkage, restoration of visual fields if any defect, reversal of galactorrhea, and restoration of fertility or abnormal sexual function. Cabergoline is preferred due to a higher frequency in normalizing the prolactin level and tumor shrinkage.

• #9 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. […] Typically, BEC is administered at an initial dose of 1.25 mg nightly with food and is gradually increased to 2.5 mg bid in 1-2 weeks, as tolerated. […] Normalization of PRL levels occurs in 85-90% of all patients with prolactinomas. […] 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.

• #10 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

  Dopamine agonist therapy is highly effective at lowering serum levels of prolactin, improving clinical consequences of hyperprolactinaemia and reducing adenoma size (strong). […] Cabergoline is the preferred dopamine agonist owing to its long half-life, high efficacy and good tolerability (strong). […] Cabergoline is used as primary medical therapy in patients with prolactinoma. For microprolactinomas and well-encased macroprolactinomas (Knosp grade 0 and 1), the curative potential and risks of surgery should be discussed with patients in a multidisciplinary setting prior to medical treatment initiation (strong). […] Patients with prolactinoma of Knosp grade 2 should be treated with cabergoline (strong). […] Patients with resistance or intolerability to other dopamine agonist therapy should be switched to cabergoline (strong).

• #11 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

  A dopamine agonist is the best first treatment for a prolactinoma of any size. Two dopamine agonists are currently available for this purpose in the United States, cabergoline and bromocriptine; another one, quinagolide, is also available in other countries. […] Dopamine agonists are very effective for decreasing prolactin levels and the size of most prolactinomas. Cabergoline, which appears to be the most effective dopamine agonist, lowers prolactin levels in approximately 90 percent of people who have prolactinomas, often to a normal level. […] If the prolactin level decreases to normal or near-normal levels, the symptoms caused by the elevated prolactin are reversed. […] If the dopamine agonist is not effective in lowering the prolactin level, or if the person cannot tolerate the side effects, surgery to attempt to remove the adenoma may be considered.

• #12 Medical treatment of prolactinomas | Nature Reviews Endocrinology

  https://www.nature.com/articles/nrendo.2011.37

  Prolactinomas, the most prevalent type of neuroendocrine disease, account for approximately 40% of all pituitary adenomas. The objectives of therapy are normalization of prolactin levels, to restore eugonadism, and reduction of tumor mass, both of which can be achieved in the majority of patients by treatment with dopamine agonists. Given their association with minimal morbidity, these drugs currently represent the mainstay of treatment for prolactinomas. […] Novel data indicate that these agents can be successfully withdrawn in a subset of patients after normalization of prolactin levels and tumor disappearance, which suggests the possibility that medical therapy may not be required throughout life. Nevertheless, multimodal therapy that involves surgery, radiotherapy or both may be necessary in some cases, such as patients who are resistant to the effects of dopamine agonists or for those with atypical prolactinomas. This Review reports on efficacy and safety of pharmacotherapy in patients with prolactinomas.

• #13 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. […] Typically, BEC is administered at an initial dose of 1.25 mg nightly with food and is gradually increased to 2.5 mg bid in 1-2 weeks, as tolerated. […] Normalization of PRL levels occurs in 85-90% of all patients with prolactinomas. […] 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.

• #14 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

  A dopamine agonist is the best first treatment for a prolactinoma of any size. Two dopamine agonists are currently available for this purpose in the United States, cabergoline and bromocriptine; another one, quinagolide, is also available in other countries. […] Dopamine agonists are very effective for decreasing prolactin levels and the size of most prolactinomas. Cabergoline, which appears to be the most effective dopamine agonist, lowers prolactin levels in approximately 90 percent of people who have prolactinomas, often to a normal level. […] If the prolactin level decreases to normal or near-normal levels, the symptoms caused by the elevated prolactin are reversed. […] If the dopamine agonist is not effective in lowering the prolactin level, or if the person cannot tolerate the side effects, surgery to attempt to remove the adenoma may be considered.

• #15 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. […] Typically, BEC is administered at an initial dose of 1.25 mg nightly with food and is gradually increased to 2.5 mg bid in 1-2 weeks, as tolerated. […] Normalization of PRL levels occurs in 85-90% of all patients with prolactinomas. […] 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.

• #16 Prolactinoma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459347/

  Most prolactinomas are managed with medical therapy only with surgery and radiotherapy reserved for refractory cases. […] Unlike other pituitary tumors, the preferred treatment for prolactinomas is medical therapy. […] Specific treatment for prolactinomas is one of the dopamine agonists. […] Treatment with dopamine agonist should be tapered and stopped if prolactin level is normal and the tumor is not visible in MRI after at least two years of treatment. […] Transsphenoidal surgery is the preferred surgical option if surgery is indicated for the following reasons: Unsuccessful medical therapy to lower prolactin level and decrease tumor size after several months of maximum dose. […] A woman with large prolactinoma (more than 3 cm) wishes to become pregnant as it can get larger during pregnancy. […] Radiation therapy should be considered for residual tumors after surgery and resistance to cabergoline therapy.

• #17 Treatment of Prolactinoma

  https://www.mdpi.com/1648-9144/58/8/1095

  The primary approach has been the use of medical therapy in the form of DAs. Bromocriptine was the treatment of choice until the emergence of cabergoline in the late 1980s-early 1990s. A comparative trial between the two agents for the treatment of hyperprolactinemic amenorrhea was published in 1994. In this study, cabergoline was superior in efficacy in restoring normoprolactinemia and ovulatory menstrual cycles, required less frequent dosing, and had fewer adverse gastrointestinal effects. Overall, cabergoline has shown superior efficacy, with evidence that prolactinomas that are resistant to bromocriptine or quinagolide may respond to cabergoline treatment, resulting in both improved biochemical control and greater tumor shrinkage. […] Given the relative ease of medical management for the majority of people with prolactinomas, surgery has until recently been largely viewed as second line therapy for patients that were intolerant or resistant to dopamine agonists. Other circumstances where surgery had a role included the setting of cerebrospinal fluid rhinorrhea, in some instances of pituitary apoplexy, cystic lesions, and to both treat and obtain histological confirmation of whether a macroadenoma with modest hyperprolactinemia is a poorly functioning macroprolactinoma or a non-functioning PitNET with stalk effect.

• #18 Clinical guidelines for diagnosis and treatment of prolactinoma and hyperprolactinemia | Endocrinología y Nutrición (English Edition)

  https://www.elsevier.es/en-revista-endocrinologia-nutricion-english-edition–412-articulo-clinical-guidelines-for-diagnosis-treatment-S2173509313001190

  Several dopamine agonists, as described below, have been used to date. […] Cabergoline: this is an ergot dopamine agonist with a long half-life which allows for once or twice weekly oral administration. […] Bromocriptine: this was the first drug introduced for the treatment of hyperprolactinemia more than 30 years ago. […] Quinagolide: this is a non-ergot dopamine agonist. […] Treatment response is defined as the normalization of PRL levels (biochemical response) and tumor size reduction. […] Resistance to dopamine agonists is defined as failure to achieve normal PRL levels with the maximum tolerated dose of dopamine agonists and the lack of a 50% reduction in tumor size. […] We usually recommend transsphenoidal surgery when treatment with dopamine agonists does not decrease PRL levels or macroadenoma size.

• #19 Treatment for a Prolactinoma – Pituitary Foundation

  https://www.pituitary.org.uk/information/prolactinoma-treatment/

  A prolactinoma is a prolactin-producing tumour of the pituitary gland. Most prolactinomas can be treated by tablets, but sometimes other treatment methods are necessary. […] Whatever the size of your prolactinoma, it is likely that your treatment will be with tablets. […] Drugs known as dopamine agonists are the first line medication in patients presenting with a prolactinoma. There are three available medications. All these drugs act by reducing prolactin secretion by the prolactinoma. […] These drugs are safe and well tolerated by most people. […] Prolactin levels often fall to normal within a few weeks of starting the treatment. In women, once prolactin has fallen to normal, menstrual cycles usually resume; interest in sex is regained and fertility is restored in most cases. In men, testosterone levels may raise, which often improves sex drive and potency.

• #20 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

  A dopamine agonist is the best first treatment for a prolactinoma of any size. Two dopamine agonists are currently available for this purpose in the United States, cabergoline and bromocriptine; another one, quinagolide, is also available in other countries. […] Dopamine agonists are very effective for decreasing prolactin levels and the size of most prolactinomas. Cabergoline, which appears to be the most effective dopamine agonist, lowers prolactin levels in approximately 90 percent of people who have prolactinomas, often to a normal level. […] If the prolactin level decreases to normal or near-normal levels, the symptoms caused by the elevated prolactin are reversed. […] If the dopamine agonist is not effective in lowering the prolactin level, or if the person cannot tolerate the side effects, surgery to attempt to remove the adenoma may be considered.

• #21 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. […] Typically, BEC is administered at an initial dose of 1.25 mg nightly with food and is gradually increased to 2.5 mg bid in 1-2 weeks, as tolerated. […] Normalization of PRL levels occurs in 85-90% of all patients with prolactinomas. […] 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.

• #22 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. In the case of very large tumors, only partial achievement of this goal may be possible. […] 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. Cabergoline may be offered as a weekly dose and may be more effective and better tolerated than Bromocriptine, which is taken daily. […] Bromocriptine shrinks the tumor and returns prolactin levels to normal in the majority of patients. To avoid side effects such as nausea and dizziness, it is important for bromocriptine treatment to start slowly. Usual maintenance doses are 2.5 (one tablet) to 7.5 mg (3 tablets) daily.

• #23 Prolactinoma – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/prolactinoma

  Prolactinomas are noncancerous tumors made up from lactotrophs in the pituitary gland. […] Treatment involves tumor inhibition with dopamine agonist drugs and sometimes removal or destruction of the adenoma. […] When indicated, initial treatment is usually with a dopamine agonist. […] The initial treatment for both sexes is usually a dopamine agonist such as bromocriptine 1.25 to 5 mg orally twice a day or the longer-acting cabergoline 0.25 to 1.0 mg orally once or twice a week, which lower prolactin levels. […] Patients with concomitant hypogonadism who elect to not use dopamine agonist therapy can be treated with estrogen (with or without a progestin, as indicated) or testosterone. […] Surgery is second-line therapy in patients whose tumor is resistant to dopamine agonists or in patients who are intolerant of medical therapy.

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

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

  Other medical treatments are available for prolactinoma patients who do not respond to BEC or for those who cannot tolerate the drug. […] Cabergoline, an ergot derivative, is a long-acting DA agonist and is available in the United States. […] 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. […] Radiation treatment (XRT) has had a less prominent role in the treatment of prolactinomas. […] Because of the excellent results produced by medical treatment, with or without surgery, XRT is seldom used.

• #25 Medication for Pituitary Tumors | American Cancer Society | American Cancer Society

  https://www.cancer.org/cancer/types/pituitary-tumors/treating/medicines.html

  Possible side effects of these drugs include drowsiness, dizziness, nausea, vomiting, diarrhea or constipation, headaches, confusion, and depression. For women whose high prolactin levels had been causing infertility, these drugs may restore fertility. Cabergoline may cause fewer side effects than bromocriptine. […] Cabergoline also can help some people with Cushings disease. For more about this drug, see Drugs for lactotroph adenomas (prolactinomas). […] A somatostatin analog might also be used after surgery if the tumor isn’t removed completely. Dopamine agonists such as cabergoline or bromocriptine also can be used. More details on these drugs are given above, in Drugs for lactotroph adenomas (prolactinomas).

• #26 TREATMENT FOR PROLACTINOMAS | Oncohema Key

  https://oncohemakey.com/treatment-for-prolactinomas/

  BROMOCRIPTINE DECREASES PROLACTIN PRODUCTION AND SECRETION, WITH A RESULTANT REDUCTION IN LACTOTROPE SIZE AND A SUBSEQUENT DECREASE IN TUMOR SIZE. […] THERAPY SHOULD BE INITIATED SLOWLY BECAUSE SIDE EFFECTS, INCLUDING NAUSEA, HEADACHE, DIZZINESS, NASAL CONGESTION, AND CONSTIPATION, MAY OCCUR. […] TO REDUCE THE GASTROINTESTINAL SIDE EFFECTS, BROMOCRIPTINE HAS BEEN ADMINISTERED INTRAVAGINALLY. REDUCTIONS IN PROLACTIN SIMILAR TO THAT ATTAINED BY ORAL BROMOCRIPTINE HAVE BEEN ACHIEVED WITH THE INTRAVAGINAL ROUTE.

• #27 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. In the case of very large tumors, only partial achievement of this goal may be possible. […] 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. Cabergoline may be offered as a weekly dose and may be more effective and better tolerated than Bromocriptine, which is taken daily. […] Bromocriptine shrinks the tumor and returns prolactin levels to normal in the majority of patients. To avoid side effects such as nausea and dizziness, it is important for bromocriptine treatment to start slowly. Usual maintenance doses are 2.5 (one tablet) to 7.5 mg (3 tablets) daily.

• #28 Prolactinoma | Endocrine Conditions

  https://www.yourhormones.info/endocrine-conditions/prolactinoma/

  A prolactinoma requires treatment only if it is causing symptoms related to high levels of prolactin in the blood level or because of its size. The aim of treatment is to normalise prolactin levels, reduce the size of large tumours and to restore normal pituitary function, thus improving quality of life. […] Most prolactinomas respond well to medication in tablet form. This treatment is very effective in reducing prolactin secretion from the tumour and reducing the tumour size. Occasionally, surgery is necessary if a prolactinoma does not respond to medication or if the patient cannot tolerate the medication. […] Medication used to treat prolactinomas belong to a group called dopamine agonists. The most used dopamine agonist is cabergoline which is taken one to two times a week. Other dopamine agonists include quinagolide and bromocriptine.

• #29 Dopamine agonist therapy for prolactinomas: do we need to rethink the place of surgery in prolactinoma management? in: Endocrine Oncology Volume 2 Issue 1 (2022)

  https://eo.bioscientifica.com/view/journals/eo/2/1/EO-21-0038.xml

  The current treatment paradigm for prolactinomas involves dopamine agonist (DA) therapy as the first-line treatment, with surgical resection reserved for cases where there is DA failure due to resistance or intolerance. […] This review highlights how DA therapy can be optimised to overcome its increasingly recognised pitfalls, whilst also addressing the potential for expanding the use of surgery in the management of prolactinomas. […] The first part of the review discusses the limitations of DA therapy, namely: DA resistance; common DA side effects; and the rare but serious DA-induced risks of cardiac valvulopathy, impulse control disorders, psychosis, CSF rhinorrhoea and tumour fibrosis. […] The second part of the review explores the role of surgery in prolactinoma management with reference to its current second-line position and recent calls for surgery to be considered as an alternative first-line treatment alongside DA therapy.

• #30

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

  Pharmacological therapy is effective in most prolactinomas, and the mainstay of care typically consists of dopamine agonists (DA)6, Cabergoline being the most commonly used drug to regulate prolactin levels and reduce tumour mass9. […] A significant challenge in the long-term management of prolactinomas is the development of drug resistance to dopamine agonists. […] While dopamine agonists are effective, they are associated with various side effects. Common side effects include nausea, dizziness, headache, and gastrointestinal disturbances41. […] Long-term use of these agents may lead to complications such as valvular heart disease and impulse control disorders42. […] Prolactinoma, although a benign pituitary tumour, may require surgical intervention if medical treatment fails to produce satisfactory results.

• #31 Prolactinoma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459347/

  Most prolactinomas are managed with medical therapy only with surgery and radiotherapy reserved for refractory cases. […] Unlike other pituitary tumors, the preferred treatment for prolactinomas is medical therapy. […] Specific treatment for prolactinomas is one of the dopamine agonists. […] Treatment with dopamine agonist should be tapered and stopped if prolactin level is normal and the tumor is not visible in MRI after at least two years of treatment. […] Transsphenoidal surgery is the preferred surgical option if surgery is indicated for the following reasons: Unsuccessful medical therapy to lower prolactin level and decrease tumor size after several months of maximum dose. […] A woman with large prolactinoma (more than 3 cm) wishes to become pregnant as it can get larger during pregnancy. […] Radiation therapy should be considered for residual tumors after surgery and resistance to cabergoline therapy.

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

  https://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. […] According to the Pituitary Society guidelines, 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. […] 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.

• #33 Medical Treatment for Prolactinoma | Stanford Health Care

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

  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.

• #34 Prolactinoma Treatment – Expert Guidance

  https://pituitarysociety.org/prolactinoma/

  Since tumor regrowth often occurs, close follow-up and repeat measurements of prolactin will be necessary after stopping medical therapy. […] In general, surgery is not recommended as primary therapy for prolactinomas because the dopamine agonists are very effective and because surgery is not always curative. […] For patients with microadenomas, pituitary surgery may be necessary if cabergoline or bromocriptine don’t work or if the medications cause serious side effects. […] If the tumor is threatening your vision, and you are trying to get pregnant, some doctors recommend treatment with bromocriptine. […] However, bromocriptine or cabergoline should be stopped as soon as you become pregnant. […] Small prolactinomas rarely increase in size, so it is not necessary to treat with cabergoline or bromocriptine to prevent tumor growth. […] When pregnancy is not an issue, your doctor may recommend treatment with estrogen or testosterone instead of bromocriptine or cabergoline. […] Prolactin levels should also be monitored during therapy with estrogen or testosterone.

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

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

  If the response to DAs is insufficient, surgical treatment should be considered to debulk the tumor volume, which may improve postoperative medical control. […] 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. […] 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. […] Surgery resulted in 67–88% long-term remission after transsphenoidal surgery and 34–52% long-term remission after DA withdrawal, whereas the normalization of PRL with DA was achieved in 81% of cases. […] Recently, the effectiveness of a new medical treatment using estrogen receptor (ER) antagonists such as tamoxifen or raloxifene was validated and showed promising results.

• #36 Clinical guidelines for diagnosis and treatment of prolactinoma and hyperprolactinemia | Endocrinología y Nutrición (English Edition)

  https://www.elsevier.es/en-revista-endocrinologia-nutricion-english-edition–412-articulo-clinical-guidelines-for-diagnosis-treatment-S2173509313001190

  Several dopamine agonists, as described below, have been used to date. […] Cabergoline: this is an ergot dopamine agonist with a long half-life which allows for once or twice weekly oral administration. […] Bromocriptine: this was the first drug introduced for the treatment of hyperprolactinemia more than 30 years ago. […] Quinagolide: this is a non-ergot dopamine agonist. […] Treatment response is defined as the normalization of PRL levels (biochemical response) and tumor size reduction. […] Resistance to dopamine agonists is defined as failure to achieve normal PRL levels with the maximum tolerated dose of dopamine agonists and the lack of a 50% reduction in tumor size. […] We usually recommend transsphenoidal surgery when treatment with dopamine agonists does not decrease PRL levels or macroadenoma size.

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

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

  The standard treatment for treating prolactinomas involves the administration of DAs, such as cabergoline (CAB) and bromocriptine (BRC). […] These medications are generally effective in normalizing prolactin levels and reducing tumor size. […] However, despite their efficacy, approximately 10%20% of patients exhibit resistance, characterized by persistent hyperprolactinemia and/or tumor growth despite maximal DA therapy. […] Therefore, understanding the mechanisms behind DA sensitivity and resistance is crucial for improving clinical outcomes. […] 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 important to note that cumulative data have not shown adverse outcomes with CAB; therefore, both medications are considered effective for use during pregnancy.

• #38 Operative treatment of cystic prolactinomas: a retrospective study | BMC Endocrine Disorders | Full Text

  https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-023-01343-0

  The optimal therapeutic approach for cystic prolactinomas remains unclear. This study aimed to evaluate the remission rates of prolactinoma patients after surgical treatment and the risk factors affecting postoperative remission in cystic prolactinoma patients. […] Early postoperative remission was achieved in 65.83% (n=27/41) of cystic prolactinomas. […] For cystic prolactinomas, tumor size and preoperative PRL levels were independent predictors of early postoperative remission. Preoperative DA therapy combined with TSS may be more beneficial to cystic prolactinoma patients. […] Cystic prolactinomas are considered when 50% of the sellar lesion volume comprised of cyst. However, cystic prolactinomas show poor response to DA due to the absence of dopamine receptors in the cystic component, which was suggested to be treated with surgical resection according to the Pituitary Society Guidelines (2006).

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

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

  Other medical treatments are available for prolactinoma patients who do not respond to BEC or for those who cannot tolerate the drug. […] Cabergoline, an ergot derivative, is a long-acting DA agonist and is available in the United States. […] 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. […] Radiation treatment (XRT) has had a less prominent role in the treatment of prolactinomas. […] Because of the excellent results produced by medical treatment, with or without surgery, XRT is seldom used.

• #40 Medical treatment of prolactinomas | Nature Reviews Endocrinology

  https://www.nature.com/articles/nrendo.2011.37

  Medical treatment of prolactinomas with cabergoline, quinagolide or bromocriptine is very efficacious; cabergoline has demonstrated superiority in efficacy to other drugs in many studies. Long-term discontinuation of cabergoline or bromocriptine in patients with hyperprolactinemia of any cause has shown a variable rate of tumor recurrence; predictors of recurrence before cabergoline withdrawal are tumor diameter and prolactin levels. Resistance to dopamine agonists is a rare phenomenon that characterizes a group of tumors that generally manifest with a more aggressive behavior than usual.

• #41 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.

• #42 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

  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. […] 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.

• #43 Prolactinoma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459347/

  Most prolactinomas are managed with medical therapy only with surgery and radiotherapy reserved for refractory cases. […] Unlike other pituitary tumors, the preferred treatment for prolactinomas is medical therapy. […] Specific treatment for prolactinomas is one of the dopamine agonists. […] Treatment with dopamine agonist should be tapered and stopped if prolactin level is normal and the tumor is not visible in MRI after at least two years of treatment. […] Transsphenoidal surgery is the preferred surgical option if surgery is indicated for the following reasons: Unsuccessful medical therapy to lower prolactin level and decrease tumor size after several months of maximum dose. […] A woman with large prolactinoma (more than 3 cm) wishes to become pregnant as it can get larger during pregnancy. […] Radiation therapy should be considered for residual tumors after surgery and resistance to cabergoline therapy.

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

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

  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.

• #45 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. Surgeons use two types of surgeries to remove prolactinomas, including: Transsphenoidal surgery: This is the most common surgery for prolactinomas. A surgeon makes an incision (small cut) at the back of your nasal cavity or under your upper lip to access your pituitary gland and the tumor. Transcranial surgery: For this surgery, a surgeon removes the tumor through an opening in your skull. They typically only use this type of surgery if the tumor is very large. […] 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.

• #46 High prolactin levels: Effects, treatments, and more

  https://www.medicalnewstoday.com/articles/what-are-the-side-effects-of-high-prolactin-levels

  Prolactinoma is a noncancerous tumor in the pituitary gland. Prolactinomas produce prolactin, which can lead to high levels of this hormone in the body. […] Treatment can help to return prolactin levels to typical levels and treat any prolactinomas that may be present. […] The most common treatment for prolactinomas is medication, which can shrink the prolactinoma and regulate prolactin levels. […] Dopamine agonists are medications that act similarly to dopamine in the brain. They are an effective treatment in shrinking prolactinomas and controlling prolactin levels. […] If medication is ineffective in treating a prolactinoma, people may require surgery to remove the tumor. […] Types of surgery to remove a prolactinoma include: Transsphenoidal surgery: This is the most common type of prolactinoma surgery. A surgeon will make a cut behind the nasal cavity or under the upper lip to carry out the procedure.

• #47 High prolactin levels: Effects, treatments, and more

  https://www.medicalnewstoday.com/articles/what-are-the-side-effects-of-high-prolactin-levels

  Transcranial surgery: People may require this type of surgery if the prolactinoma is large or has spread outside the pituitary gland. A surgeon will make an opening in the skull to remove the tumor. […] Prolactinoma, a benign tumor of the pituitary gland, can also cause high prolactin levels. People may need medications or surgery to shrink the tumor and reduce prolactin levels.

• #48 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. […] Gamma Knife radiosurgery is a highly advanced form of radiation therapy that can achieve results similar to those in the surgical techniques described above. The ‘knife’ in this surgery consists of many small beams of radiation focused on a single point. Each beam is too weak to damage healthy tissue, but at the point where the beams converge, they deliver a dose of radiation that’s lethal to the tumor.

• #49 Prolactinoma Symptoms & Treatment | PNI Pituitary Disorders

  https://www.pacificneuroscienceinstitute.org/pituitary-disorders/conditions/pituitary-adenomas/prolactinoma/

  Because of improved tumor visualization, the endoscopic endonasal approach is rapidly becoming the preferred method for removal of most pituitary adenomas, including prolactinomas who are not responsive to cabergoline. […] Because most patients with prolactinomas respond so well to dopamine agonist therapy and/or surgery, radiosurgery or radiation therapy are rarely required.

• #50 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. […] Prolactin levels return to normal in 1 out of 3 patients treated with radiation therapy. […] Having a prolactinoma may make it difficult for you to become pregnant, but treatment with dopamine agonists is very effective in restoring fertility. […] Although studies suggest that both bromocriptine and cabergoline can be safely taken in the early stages of pregnancy, bromocriptine is typically preferred because of its longer safety record.

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

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

  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.

• #52 Clinical guidelines for diagnosis and treatment of prolactinoma and hyperprolactinemia | Endocrinología y Nutrición (English Edition)

  https://www.elsevier.es/en-revista-endocrinologia-nutricion-english-edition–412-articulo-clinical-guidelines-for-diagnosis-treatment-S2173509313001190

  Surgical cure rates range from 75% to 90% for microadenomas and from 18% to 80% for macroadenomas. […] We suggest that radiotherapy only be used in patients with big tumors who are not candidates for surgery and who do not respond to dopamine agonists or cannot be treated with them, and in patients with aggressive prolactinoma or carcinoma.

• #53 Clinical guidelines for diagnosis and treatment of prolactinoma and hyperprolactinemia | Endocrinología y Nutrición (English Edition)

  https://www.elsevier.es/pt-revista-endocrinologia-nutricion-english-edition–412-articulo-clinical-guidelines-for-diagnosis-treatment-S2173509313001190

  Cabergoline is recommended as the first choice because of its greater efficacy (both in terms of normalization of PRL levels and tumor size decrease) and better tolerability. […] The treatment of drug-induced hyperprolactinemia should be restricted to symptomatic patients in whom the concerned drug cannot be discontinued or replaced. […] We usually recommend transsphenoidal surgery when treatment with dopamine agonists does not decrease PRL levels or macroadenoma size. […] We suggest that pituitary surgery be performed at hospitals where at least 25 pituitary surgeries are performed annually. […] We suggest that temozolomide be used in patients with malignant or invasive prolactinomas not controlled with surgery and radiotherapy.

• #54 Prolactinoma and Ayurveda By: Tesia Love – California College of Ayurveda

  https://www.ayurvedacollege.com/blog/prolactinomaandayurveda/

  Side effects of the listed dopaminergic drugs may include dizziness and nausea. In addition, the efficacy of the drugs may decrease with long-term use, so for both reasons, patients are started on low doses with dosage increased as needed. Most patients are able to tolerate these drugs, particularly cabergoline and quinagolide, but there are some people who are unable, and therefore, have to defer to other treatment options. Surgery and radiotherapy are the other two treatment options when a patient refuses or fails to respond well to pharmaceuticals. Side effects of surgery may include damage to the normal tissue of the pituitary gland resulting in diabetes insipidus or the need for hormone replacement therapy. Other rare side effects of surgery may include post-operative bleeding, spinal fluid leak, stroke, or death.

• #55

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

  Trans-sphenoidal surgery is generally considered a safe procedure with a complication rate of less than 1%49. […] Radiation therapies serve as an alternative option when conventional treatments fail to manage tumour growth or prolactin levels adequately. […] These therapies are particularly beneficial for patients experiencing persistent hypersecretion of growth hormone after unsuccessful surgical intervention, providing a targeted approach to managing the condition and improving outcomes60. […] Dopamine agonists like bromocriptine and Cabergoline are commonly prescribed to manage prolactinomas, a type of tumour associated with elevated levels of prolactin hormone. […] Despite their efficacy, dopamine agonists are typically discontinued during pregnancy, although they may need to be resumed if the tumour shows significant growth. […] Emerging treatment options and potential future directions in prolactinoma management, offering insights into novel therapeutic avenues.

• #56 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.

• #57 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

  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. […] 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.

• #58 Prolactinoma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459347/

  Most prolactinomas are managed with medical therapy only with surgery and radiotherapy reserved for refractory cases. […] Unlike other pituitary tumors, the preferred treatment for prolactinomas is medical therapy. […] Specific treatment for prolactinomas is one of the dopamine agonists. […] Treatment with dopamine agonist should be tapered and stopped if prolactin level is normal and the tumor is not visible in MRI after at least two years of treatment. […] Transsphenoidal surgery is the preferred surgical option if surgery is indicated for the following reasons: Unsuccessful medical therapy to lower prolactin level and decrease tumor size after several months of maximum dose. […] A woman with large prolactinoma (more than 3 cm) wishes to become pregnant as it can get larger during pregnancy. […] Radiation therapy should be considered for residual tumors after surgery and resistance to cabergoline therapy.

• #59 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

  Surgery could be offered to patients who have intolerance or resistance to long-term dopamine agonist therapy (weak). […] Radiation therapy should be reserved for patients who show poor mass shrinkage in response to dopamine agonists and have either non-resectable residual adenoma tissue after surgery or contraindications for surgery (strong). […] Cystic prolactinomas might respond to dopamine agonist therapy, which should be considered a viable option, particularly in patients without urgent need of optic chiasm decompression (strong). […] The presence of a cystic component is not uncommon in all pituitary adenomas and should be distinguished from predominantly cystic prolactinomas, in which usually more than 50% of the volume is fluid-filled.

• #60 Clinical guidelines for diagnosis and treatment of prolactinoma and hyperprolactinemia | Endocrinología y Nutrición (English Edition)

  https://www.elsevier.es/pt-revista-endocrinologia-nutricion-english-edition–412-articulo-clinical-guidelines-for-diagnosis-treatment-S2173509313001190

  Cabergoline is recommended as the first choice because of its greater efficacy (both in terms of normalization of PRL levels and tumor size decrease) and better tolerability. […] The treatment of drug-induced hyperprolactinemia should be restricted to symptomatic patients in whom the concerned drug cannot be discontinued or replaced. […] We usually recommend transsphenoidal surgery when treatment with dopamine agonists does not decrease PRL levels or macroadenoma size. […] We suggest that pituitary surgery be performed at hospitals where at least 25 pituitary surgeries are performed annually. […] We suggest that temozolomide be used in patients with malignant or invasive prolactinomas not controlled with surgery and radiotherapy.

• #61 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. […] Gamma Knife radiosurgery is a highly advanced form of radiation therapy that can achieve results similar to those in the surgical techniques described above. The ‘knife’ in this surgery consists of many small beams of radiation focused on a single point. Each beam is too weak to damage healthy tissue, but at the point where the beams converge, they deliver a dose of radiation that’s lethal to the tumor.

• #62 Prolactinoma – UF Health

  https://ufhealth.org/conditions-and-treatments/prolactinoma

  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. […] Radiation is usually only used in people with a prolactinoma that continues to grow or gets worse after both medicine and surgery have been tried. Radiation may be given in the form of: Conventional radiation; Gamma knife (stereotactic radiosurgery) — a type of radiation therapy that focuses high-powered x-rays on a small area in the brain. […] Treatment for prolactinoma may change the levels of other hormones in the body, especially if surgery or radiation is performed.

• #63 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. […] Prolactin levels return to normal in 1 out of 3 patients treated with radiation therapy. […] Having a prolactinoma may make it difficult for you to become pregnant, but treatment with dopamine agonists is very effective in restoring fertility. […] Although studies suggest that both bromocriptine and cabergoline can be safely taken in the early stages of pregnancy, bromocriptine is typically preferred because of its longer safety record.

• #64 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

  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. […] 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.

• #65 Prolactinoma therapy – USZ

  https://www.usz.ch/en/department/endocrinology/service/prolactinoma-therapy/

  In over 90 percent of those treated, these drugs respond so well that the prolactin level normalizes. […] If you cannot tolerate the medication, it may be advisable to change the medication or even have the prolactinoma surgically removed. This also applies if the medication does not have the desired therapeutic effect. […] In most cases, the procedure is performed minimally invasively via the nose. […] Radiotherapy is therefore only used if neither treatment with medication nor surgery can alleviate the symptoms sufficiently.

• #66 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. […] Prolactin levels return to normal in 1 out of 3 patients treated with radiation therapy. […] Having a prolactinoma may make it difficult for you to become pregnant, but treatment with dopamine agonists is very effective in restoring fertility. […] Although studies suggest that both bromocriptine and cabergoline can be safely taken in the early stages of pregnancy, bromocriptine is typically preferred because of its longer safety record.

• #67 Prolactinoma Treatment – Expert Guidance

  https://pituitarysociety.org/prolactinoma/

  Since tumor regrowth often occurs, close follow-up and repeat measurements of prolactin will be necessary after stopping medical therapy. […] In general, surgery is not recommended as primary therapy for prolactinomas because the dopamine agonists are very effective and because surgery is not always curative. […] For patients with microadenomas, pituitary surgery may be necessary if cabergoline or bromocriptine don’t work or if the medications cause serious side effects. […] If the tumor is threatening your vision, and you are trying to get pregnant, some doctors recommend treatment with bromocriptine. […] However, bromocriptine or cabergoline should be stopped as soon as you become pregnant. […] Small prolactinomas rarely increase in size, so it is not necessary to treat with cabergoline or bromocriptine to prevent tumor growth. […] When pregnancy is not an issue, your doctor may recommend treatment with estrogen or testosterone instead of bromocriptine or cabergoline. […] Prolactin levels should also be monitored during therapy with estrogen or testosterone.

• #68

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

  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. […] One of the biggest changes with prolactinoma treatment in recent years is a choice of medication or surgery as first-line therapy. […] The statement said surgery by an experienced neurosurgeon offers a high chance of cure, is cost-effective and avoids long-term dopamine agonist treatment. […] For women with microprolactinomas and intrasellar macroprolactinomas, dopamine agonist therapy is rarely continued in pregnancy, according to Fleseriu. […] For large adenomas, either bromocriptine or cabergoline can be continued to prevent tumor enlargement, Fleseriu said.

• #69

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

  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, Fleseriu said. […] The consensus statement recommends those with a well-controlled microprolactinoma enter into a dopamine agonist withdrawal trial as menopause is associated with a physiological decrease in circulating prolactin. […] Further research is required to develop better algorithms to inform the patient about the most effective treatment approach for their specific situation, Petersenn said. […] The consensus statement recommends temozolomide treatment if the maximum-tolerated dose of dopamine agonist therapy is reached, but Petersenn said, more studies are needed.

• #70 Prolactinoma | Brain Institute | OHSU

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

  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.

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

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

  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.

• #72 Prolactinoma | Brain Institute | OHSU

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

  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.

• #73 Operative treatment of cystic prolactinomas: a retrospective study | BMC Endocrine Disorders | Full Text

  https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-023-01343-0

  The optimal therapeutic approach for cystic prolactinomas remains unclear. This study aimed to evaluate the remission rates of prolactinoma patients after surgical treatment and the risk factors affecting postoperative remission in cystic prolactinoma patients. […] Early postoperative remission was achieved in 65.83% (n=27/41) of cystic prolactinomas. […] For cystic prolactinomas, tumor size and preoperative PRL levels were independent predictors of early postoperative remission. Preoperative DA therapy combined with TSS may be more beneficial to cystic prolactinoma patients. […] Cystic prolactinomas are considered when 50% of the sellar lesion volume comprised of cyst. However, cystic prolactinomas show poor response to DA due to the absence of dopamine receptors in the cystic component, which was suggested to be treated with surgical resection according to the Pituitary Society Guidelines (2006).

• #74 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

  Surgery could be offered to patients who have intolerance or resistance to long-term dopamine agonist therapy (weak). […] Radiation therapy should be reserved for patients who show poor mass shrinkage in response to dopamine agonists and have either non-resectable residual adenoma tissue after surgery or contraindications for surgery (strong). […] Cystic prolactinomas might respond to dopamine agonist therapy, which should be considered a viable option, particularly in patients without urgent need of optic chiasm decompression (strong). […] The presence of a cystic component is not uncommon in all pituitary adenomas and should be distinguished from predominantly cystic prolactinomas, in which usually more than 50% of the volume is fluid-filled.

• #75 Operative treatment of cystic prolactinomas: a retrospective study | BMC Endocrine Disorders | Full Text

  https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-023-01343-0

  Therefore, they are potentially more resistant to DA and surgical treatment was suggested to be the first-line therapeutic approach for patients with large cystic prolactinomas. […] In summary, our data indicated that early remission rates after TSS of prolactinomas remained excellent in solid microadenomas and cystic prolactinomas. Tumor size and preoperative PRL levels were independent factors related to remission after cystic prolactinomas resection. For cystic prolactinoma, preoperative DA therapy combined with TSS may be more beneficial to patients.

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

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

  Other medical treatments are available for prolactinoma patients who do not respond to BEC or for those who cannot tolerate the drug. […] Cabergoline, an ergot derivative, is a long-acting DA agonist and is available in the United States. […] 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. […] Radiation treatment (XRT) has had a less prominent role in the treatment of prolactinomas. […] Because of the excellent results produced by medical treatment, with or without surgery, XRT is seldom used.

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

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

  If the response to DAs is insufficient, surgical treatment should be considered to debulk the tumor volume, which may improve postoperative medical control. […] 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. […] 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. […] Surgery resulted in 67–88% long-term remission after transsphenoidal surgery and 34–52% long-term remission after DA withdrawal, whereas the normalization of PRL with DA was achieved in 81% of cases. […] Recently, the effectiveness of a new medical treatment using estrogen receptor (ER) antagonists such as tamoxifen or raloxifene was validated and showed promising results.

• #78

  https://link.springer.com/article/10.1007/s11102-019-00987-3

  Consensus guidelines recommend dopamine agonists (DAs) as the mainstay treatment for prolactinomas. […] In these cases, alternative medical treatments have been considered but data on their efficacy should be interpreted within the constraints of publication bias and of lack of relevant clinical trials. […] Current practice guidelines recommend several possible approaches for patients with DA-resistant prolactinomas. […] The above described options to overcome DA-resistance may not always be successful and in this setting, the value of alternative medical agents has been investigated. […] Overall, data on the use of estrogen modulators in prolactinomas not responding to DAs are limited and inconclusive. […] Temozolomide (TMZ) is considered the first-line chemotherapeutic agent for aggressive pituitary tumors and carcinomas.

• #79 Cedars-Sinai Study Leverages Oncology Research to Improve Outcomes for Patients with Aggressive Prolactinomas | Cedars-Sinai

  https://www.cedars-sinai.org/blog/oncology-research-improve-patient-outcomes.html

  For this research study, Cooper and her colleagues chose the drug lapatinib to test reduction in prolactin and tumor size. […] „We collected tissue from human prolactinomas and saw that, with lapatinib, the prolactin levels went down. […] With doses of lapatinib, 75% of trial enrollees achieved stabilization of their tumor. […] „The results suggested that tyrosine kinase inhibitors like lapatinib can play a role in treating these rare, aggressive prolactinomas,” says Cooper. […] „While lapatinib is well tolerated, each physician has to work with their team to weigh the benefits and risks of the therapies and determine what the best course of action is for their patients,” she adds. […] At Cedars-Sinai’s Pituitary Center, the team is multidisciplinary, with leading surgeons, endocrinologists, radiation and neuro-oncologists and researchers all partnering to deliver the most effective therapies and treatments to their patients.

• #80 Aripiprazole in the treatment of prolactinoma | Society for Endocrinology

  https://www.endocrinology.org/endocrinologist/121-autumn16/hot-topics/aripiprazole-in-the-treatment-of-prolactinoma/

  Prolactinomas that coincide with concomitant psychotic disorders can prove a considerable challenge to treat. A number of dopaminergic drugs are the standard therapeutic treatment for prolactinoma, but their side-effects include aggravating psychotic symptoms. […] Following treatment with a series of dopaminergic drugs, the team struggled to balance the improvements in her pituitary disease with changes to her psychotic health. The patient was commenced on aripiprazole, a relatively novel antipsychotic drug, not associated with an increase in prolactin levels. […] Over a 10-year follow up, the authors report that use of this drug led to improved psychotic symptoms, normalised prolactin levels and a decrease in prolactinoma size. They conclude that aripiprazole can be a valuable pharmaceutical tool to treat both prolactinoma and psychosis.

• #81 Successful treatment of a prolactinoma with the antipsychotic drug aripiprazole in: Endocrinology, Diabetes & Metabolism Case Reports Volume 2016 Issue 1 (2016)

  https://edm.bioscientifica.com/view/journals/edm/2016/1/EDM16-0028.xml

  In this report, we describe a female patient with both prolactinoma and psychotic disorder who was successfully treated with aripiprazole, a partial dopamine 2 receptor agonist. During the follow-up of more than 10 years, her psychotic symptoms improved considerably, prolactin levels normalised and the size of the prolactinoma decreased. This observation may be of clinical relevance in similar patients who often are difficult to treat with the regular dopaminergic drugs. […] Prolactinoma coinciding with psychosis can represent a therapeutic challenge. […] In contrast to many other antipsychotic drugs, aripiprazole is associated with a decrease in prolactin levels. […] Aripiprazole can be a valuable pharmaceutical tool to treat both prolactinoma and psychosis. […] The treatment of a patient with prolactinoma and a concomitant psychotic disorder poses a particular challenge: psychotic symptoms are mostly treated with dopamine receptor D2 antagonists and the majority of antipsychotic agents can cause marked increases in prolactin levels as adverse events, which is particularly undesirable in patients with prolactinoma.

• #82 Successful treatment of a prolactinoma with the antipsychotic drug aripiprazole in: Endocrinology, Diabetes & Metabolism Case Reports Volume 2016 Issue 1 (2016)

  https://edm.bioscientifica.com/view/journals/edm/2016/1/EDM16-0028.xml

  Aripiprazole is a relatively novel antipsychotic drug. In contrast to most other antipsychotics, aripiprazole is not associated with an increase in prolactin levels and may even result in a decrease in prolactin secretion. […] This case report describes a patient with a prolactinoma who experienced psychotic symptoms as side effects of treatment with dopamine receptor agonists. Treatment with aripiprazole, however, resulted in a favourable response to both psychotic symptoms and prolactinoma. […] This case report illustrates the prolactin lowering effect of aripiprazole in a patient with psychiatric disease and a concomitant prolactinoma during an extensive period of follow-up. Long-term normoprolactinaemia was observed during the use of aripiprazole as monotherapy. […] Our case also illustrates that a reduction in prolactinoma size of comparable proportion as observed during treatment with the classic dopaminergic drugs such as bromocriptine, quinagolide or cabergoline can also be observed during aripiprazole treatment.

• #83 Prolactinoma Treatment – Expert Guidance

  https://pituitarysociety.org/prolactinoma/

  The treatment of choice for all patients with prolactinomas is a prescription medication for drugs called dopamine agonists. These drugs work like dopamine to control prolactin secretion. […] The two drugs approved for the treatment of hyperprolactinemia in the United States are Parlodel (bromocriptine) and Dostinex (cabergoline). […] All of the approved drugs are available in generic form and are effective at lowering prolactin levels and reducing tumor size in over 90% of patients. Prolactin levels typically normalize within days and tumor shrinkage is usually apparent within 3-6 months after therapy is started. […] The major disadvantage of bromocriptine and cabergoline is that stopping either drug leads to the recurrence of hyperprolactinemia and tumor regrowth. […] If you have a microadenoma, your doctor will likely recommend treatment for at least two years before considering tapering or stopping the drug.

• #84 Prolactinoma | Endocrine Conditions

  https://www.yourhormones.info/endocrine-conditions/prolactinoma/

  Dosages are titrated to prolactin levels, so regular blood tests are performed. The aim of the therapy is to achieve a normal prolactin level, ideally with a reduction in the size of the prolactinoma. […] Side-effects of dopamine agonists include nausea, vomiting, loss of appetite, dizziness and drowsiness. Taking the medication with food and in the evening can reduce some of these side effects. […] The outcome for patients with prolactinomas is usually excellent as the majority respond well to medication. However, they will require regular monitoring by their GP and/or an endocrinologist. As the prolactin level returns to normal the function of the ovaries and testes returns to normal, including recovery of fertility. Contraception should still be used in the normal way to prevent pregnancy. However, if conception is desired and pregnancy is confirmed, the doctor will usually ask the patient to stop taking dopamine agonist medication. A small proportion of patients (generally those with larger tumours) will need to continue with dopamine agonist therapy during pregnancy. The frequency of follow-up during pregnancy will depend on the size of the prolactinoma. […] In the long-term, a proportion of patients with a prolactinoma, particularly if they have normal prolactin levels and their prolactinoma has become smaller with dopamine agonist treatment may trial discontinuing dopamine agonist treatment.

• #85 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. In the case of very large tumors, only partial achievement of this goal may be possible. […] 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. Cabergoline may be offered as a weekly dose and may be more effective and better tolerated than Bromocriptine, which is taken daily. […] Bromocriptine shrinks the tumor and returns prolactin levels to normal in the majority of patients. To avoid side effects such as nausea and dizziness, it is important for bromocriptine treatment to start slowly. Usual maintenance doses are 2.5 (one tablet) to 7.5 mg (3 tablets) daily.

• #86 Treatment for a Prolactinoma – Pituitary Foundation

  https://www.pituitary.org.uk/information/prolactinoma-treatment/

  Nearly all prolactinomas shrink in size following treatment with the tablets. […] The use of surgery and radiotherapy for prolactinomas has declined in recent years, due to the remarkable effectiveness of tablet treatment. If your prolactinoma does not shrink with tablet treatment (less than 10%) or you suffer side-effects, then surgery may be required, particularly if your vision has not improved. […] If a large prolactinoma does shrink effectively following tablet treatment, most specialists simply continue the drug, but perhaps in a reduced dose. General pituitary function may improve after tumour shrinkage has occurred. […] However, if you continue to have pituitary under-activity following treatment of your prolactinoma, then hormone supplements may be required.

• #87 Prolactinoma therapy – USZ

  https://www.usz.ch/en/department/endocrinology/service/prolactinoma-therapy/

  If the prolactinoma is very small and does not cause any symptoms, there is usually no treatment. However, if symptoms occur, there are various treatment options available. […] Prolactinomas usually respond very well to medication so-called dopamine agonists. These active substances bind to special docking sites on the surface of the prolactin-producing cells. This inhibits the release of prolactin and also ensures that the tissue overgrowth becomes smaller over time. […] You will normally have to take the medication for several years. During this time, we regularly check the prolactin level in the blood and the function of the rest of the pituitary gland. […] Only patients who take a higher dosage of the medication over a longer period of time also require ultrasound checks of the heart valves.

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

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

  Prolactinomas have been managed uniformly, with dopamine agonists as the primary treatment. […] This review aims to support endocrinologists in making better clinical decisions and improving patient care by examining predictive markers for dopamine agonist sensitivity, as well as the clinical characteristics and suitability of transsphenoidal adenomectomy as a potential first-line treatment. […] 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. […] The traditional management of prolactinomas has involved the use of dopamine agonists (DAs) as the first-line treatment. […] However, variability in the response to DAs and potential side effects pose challenges in clinical practice.

• #89 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

  The need for long-term dopamine agonist treatment and the limited chances of permanent cure should be highlighted in patient discussions (strong). […] 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. Surgery by an expert pituitary neurosurgeon should therefore be discussed alongside dopamine agonist treatment as a first-line option in this subgroup of patients (strong). […] Medical treatment is the preferred first-line treatment option in patients with a low chance of surgical remission (Knosp grade 2) (strong). […] Surgery could be recommended over medical treatment in patients with rapidly progressive vision loss due to a sellar mass effect or apoplexy (weak).

• #90

  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. […] 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.

• #91 Dopamine agonist therapy for prolactinomas: do we need to rethink the place of surgery in prolactinoma management? in: Endocrine Oncology Volume 2 Issue 1 (2022)

  https://eo.bioscientifica.com/view/journals/eo/2/1/EO-21-0038.xml

  Randomised trials comparing medical vs surgical therapy for prolactinomas are currently underway. […] Pending these results, a low surgical threshold approach is herein proposed, whereby DA therapy remains the default treatment for prolactinomas unless there are specific triggers to consider surgery, including concern regarding DA side effects or risks in vulnerable patients, persistent and bothersome DA side effects, emergence of any serious risks of DA therapy, expected need for long-term DA therapy, as well as the traditional indications for surgery. […] This approach should optimise the use of DA therapy for those who will most benefit from it, whilst instituting surgery early in others in order to minimise the cumulative burden of prolonged DA therapy.

• #92 Treatment Clinical Trials for Pituitary Gland Tumor – NCIFacebookFollow on XInstagramYoutubeLinkedin

  https://www.cancer.gov/research/participate/clinical-trials/disease/pituitary-gland-tumor/treatment

  A Study of Pasireotide in People With Prolactinoma […] Clinical trials are research studies that involve people. The clinical trials on this list are for pituitary gland tumor treatment. […] You may want to think about taking part in a clinical trial. Talk to your doctor for help in deciding if one is right for you.

• #93 Clinical Trials to Treat Pituitary Tumors – NCIFacebookFollow on XInstagramYoutubeLinkedin

  https://www.cancer.gov/research/participate/clinical-trials/pituitary-tumors

  A Study of Pasireotide in People With Prolactinoma […] Status: Active […] Location: 7 locations

• #94 Prolactinoma: Symptoms, Diagnosis and Treatment

  https://patient.info/hormones/prolactinoma

  A prolactinoma occurs when some of the cells in the pituitary gland (the ones producing prolactin) multiply more than usual to form a small growth (tumour) in the pituitary gland. The prolactinoma makes too much prolactin and this can cause symptoms. […] Treatment usually works well to stop the symptoms of prolactinoma and to improve fertility. There are various options to treat prolactinomas but the usual treatment is medication. Some treatment options depend on the size of the growth. […] Medication is a very effective treatment for most prolactinomas. The medication is a type called dopamine agonists. These act on the pituitary gland to reduce the amount of prolactin it makes, and they can also shrink the tumour. […] Surgery may be an option if medication does not work, is not wanted, or for larger prolactinomas. The operation is called trans-sphenoidal surgery, because the surgeon gets to the pituitary gland through the sphenoid bone, via a small cut above the upper front teeth or from inside a nostril. It is done under general anaesthetic. […] 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.

• #95 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

  The need for long-term dopamine agonist treatment and the limited chances of permanent cure should be highlighted in patient discussions (strong). […] 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. Surgery by an expert pituitary neurosurgeon should therefore be discussed alongside dopamine agonist treatment as a first-line option in this subgroup of patients (strong). […] Medical treatment is the preferred first-line treatment option in patients with a low chance of surgical remission (Knosp grade 2) (strong). […] Surgery could be recommended over medical treatment in patients with rapidly progressive vision loss due to a sellar mass effect or apoplexy (weak).

• #96

  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. […] 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.

• #97 What Is a Prolactinoma?

  https://www.healthline.com/health/endocrine-health/prolactinoma

  A prolactinoma is a benign pituitary tumor that makes the hormone prolactin. Most are treated with medications. […] If you’re experiencing symptoms and need treatment, your doctor may prescribe dopamine agonists. These medications can help manage prolactin levels and shrink the tumor. Examples of dopamine agonists include bromocriptine (Parlodel, Cycloset) and cabergoline. […] If a prolactinoma doesn’t respond to medications, your doctor may recommend surgery to remove the tumor. Radiation therapy is another treatment option for prolactinomas that can’t be effectively treated with medications or surgery. […] Prolactinomas are typically treated with medications. When a tumor doesn’t respond well to medications, surgery may be needed to remove the tumor. […] Overall, the outlook for prolactinomas is very good. These tumors can typically be treated easily with medications.

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