Novel approaches to the management of hyperprolactinemia

With improved radiologic detection and monitoring of prolactinomas, the management has shifted away from surgery toward a more conservative approach and medical management. The natural course of a microadenoma appears to be that of a non-progression, and for asymptomatic patients serial radiologic monitoring for growth may be a safe form of management. For symptomatic women, medical management remains the primary mode of therapy. Although bromocriptine remains the most widely used dopamine agonist, its side effects and short half-life have led to the development of newer agonists with better tolerance and similar or superior efficacy. Patients who tolerate oral bromocriptine poorly may find the medication more acceptable when administered either parenterally as with Parlodel LA (Sandoz, Basel, Switzerland), or vaginally. Different medications that have similar efficacy and tolerance to bromocriptine such as pergolide or cabergoline [corrected] may also represent alternatives, as intolerance to one ergot agonist does not necessarily imply intolerance to another. CV-205-502 (Sandoz), a promising and new long-acting nonergot derivative, appears to be safe, effective, and very well tolerated.