When is treatment of prolactinomas indicated?

Updated: Mar 25, 2018
  • Author: Venkatesh Babu Segu, MD, MBBS, DM; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Treatment is indicated if mass effects from the tumor and/or significant effects from hyperprolactinemia are present. [8, 25]

Although the natural history of prolactinomas is unclear, most microprolactinomas (up to 95%) do not progress to macroadenomas, as determined after a 4- to 6-year observation period. Hence, if a patient with a microprolactinoma has minimal symptoms, the patient can be monitored closely with serial estimations of serum PRL levels combined with imaging studies at yearly intervals. However, if a patient with a microprolactinoma has significant effects from the hyperprolactinemia, treatment is indicated.

Any patient with macroprolactinoma needs treatment, because the tumor has already shown a propensity to grow. Such treatment includes the following:


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