Prolactinoma medical therapy

Medical therapy for prolactinoma includes dopamine agonists (either cabergoline or bromocriptine). The goals of treatment include lowering the prolactin secretion to normal, reduction of tumor size, correction of any visual abnormalities, and restoration of normal pituitary function.

• Medical therapy for prolactinoma includes dopamine agonists (cabergoline or bromocriptine).^{[1][2][3][4][5]}
  • Preferred regimen: Cabergoline 0.25 mg PO twice weekly or 0.5 mg PO once per week
    • The dose may be gradually increased every 4 weeks as needed
    • The maximum dose can be administered up to 1 mg PO twice per week
  • Alternative regimen: Bromocriptine 1.25 mg PO once daily at bedtime for 1 week
    • The dose may be gradually increased every 3 to 7 days as needed and taken in divided doses

• These drugs reduce the tumor size in approximately 85% of cases and lower the prolactin concentration to normal in more than 90% of patients.
• Both drugs have been approved by the U.S Food and Drug Administration for the treatment of hyperprolactinemia.

• Bromocriptine is considered safe to use during pregnancy.^[1]

• Dopamine therapy can be tapered down to lower doses if the patient fulfills the following criteria:^[1]
  • Normal prolactin level for at least 2 years.
  • Reduction in tumor size by at least 50%.
  • No compression of optic chiasm.
• Drug cessation can be tried if:
  • Cavernous sinus invasion is not present.

• Rarely, radiation therapy is used if medical therapy and surgery fail to reduce prolactin concentration. Depending on the size and location of the tumor, radiation is delivered either in low doses over the course of 5 to 6 weeks or in a single high dose. Radiation therapy is effective in approximately 30% of cases.^[2]

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