Prolactinoma - Treatment

Authored by Dr Colin Tidy, 12 May 2017

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The Information Standard

Reviewed by:
Dr John Cox, 12 May 2017

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

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.

The dopamine agonists are called bromocriptine, cabergoline or quinagolide. They are taken as tablets.

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

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.

Other treatments

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

I’ve had two blood test indicating high prolactin levels and I display most symptoms of a prolactinoma, I’m not getting an mri for another 3 weeks and I’m feeling rather anxious to understand what’s...

lily1993
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