Medical therapy for prolactinomas and somatotroph adenomas

To review the current recommendations for medical treatment of prolactinomas and somatotroph adenomas.

The spectrum of symptoms of hyperprolactinemia and the clinical features of acromegaly are elaborated, and the various medical therapeutic options for management of prolactinomas and somatotroph adenomas are discussed.

In patients with prolactinomas, medical therapy with a dopamine agonist constitutes the primary treatment and is usually associated with normalization of prolactin levels, tumor shrinkage, and resolution of clinical symptoms. For patients intolerant of bromocriptine, currently the only available dopamine agonist approved for prolactinomas in the United States, several other options can be explored. Somatotroph adenomas are treated first by using a transsphenoidal neurosurgical approach. For those patients not cured, medical therapy with octreotide, a somatostatin analogue, can be effective in biochemical and symptomatic control of the residual acromegaly. This medical option can be used in conjunction with radiation therapy while awaiting its effects or as the sole secondary therapy for this disorder.

Medical therapy has an important role in the management of prolactinomas and somatotroph adenomas.