How is prolactinoma treated in hyperpituitarism?

Updated: Oct 24, 2016
  • Author: Alicia Diaz-Thomas, MD, MPH; Chief Editor: Robert P Hoffman, MD  more...
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Answer

Prolactinoma is the only pituitary adenoma for which long-term medical management is fully satisfactory. Unless the patient presents with an acute threat to vision, hydrocephalus, cerebrospinal fluid leak, or other surgical emergency, medical management with dopamine agonists should be attempted before surgical treatment is considered. Dopamine agonists are potent suppressors of PRL secretion and promptly lower serum PRL levels, abolish galactorrhea, and restore normal gonadal function in most patients with hyperprolactinemia of any cause. Dopamine agonists can also inhibit tumor cell replication in 60-80% of prolactinomas. In small tumors, dopamine agonists cause tumor shrinkage, while the results vary in larger tumors. Successful long-term use of these drugs can obviate the need for pituitary surgery.


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