What are the treatment options for prolactinomas?
Treatment usually works well to stop the symptoms of prolactinoma and to improve fertility. There are various treatments but the usual treatment is medication.
Not treating may be an option
For a small prolactinoma (a microprolactinoma), if symptoms are not too troublesome then one option is just to monitor the situation. This means having regular blood tests and possibly scans. If symptoms get worse or the prolactinoma seems to be growing, treatment can be started whenever necessary.
If you are choosing the no-treatment option, you may be advised to take oestrogen hormones (for women) or testosterone hormones (for men). This can help to prevent 'thinning' of the bones (osteoporosis).
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. Usually with this medication, prolactin levels go down to normal in a few weeks. Dopamine agonists can be taken as long-term treatment.
What about treatment with medication in pregnancy?
If you are planning a pregnancy, it is best to discuss treatment options with your doctor beforehand. Treating the prolactinoma usually improves fertility, so can help you become pregnant. Bromocriptine is thought to be the safest of the dopamine agonists for pregnancy, because it is the most tried and tested one. Many women have had babies after taking bromocriptine.
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.
Sometimes prolactinomas cause a reduction in the other hormones that the pituitary gland produces. If so, you may need to take tablets to replace these hormones. This will depend on your symptoms and blood test results.
Further reading and references
Molitch ME; Endotext. Prolactinoma Management. April 2015.
Molitch ME; Diagnosis and Treatment of Pituitary Adenomas: A Review. JAMA. 2017 Feb 7317(5):516-524. doi: 10.1001/jama.2016.19699.
Brue T, Castinetti F; The risks of overlooking the diagnosis of secreting pituitary adenomas. Orphanet J Rare Dis. 2016 Oct 611(1):135.
Position statement on the use of dopamine agonists in endocrine disorders; Society for Endocrinology (Feb 2009 - reviewed Nov 2011)
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