[The treatment of prolactinoma]

Prolactinoma is the most common type of secretory pituitary tumor. The clinical presentation varies with age and sex, and the size of the adenoma. The differential diagnosis with nonfunctioning adenoma and hyperprolactinemia is particularly important in selecting an appropriate therapy. The choice of therapy depends on a number of factors including the patient's preference. In cases of radiologically undetectable microprolactinomas, we prefer observation only. However, hypogonadic patients are treated with bromocriptine. Generally, it is our recommendation that almost all of the patients with micro--and macroprolactinomas undergo a primary medical therapy, provided they are willing to continue such therapy on a long term basis. We recommend transsphenoidal surgery for patients who refuse long term medical therapy and in rare cases of prolactinomas which are unresponsive to medical therapy. We also consider surgery as a valuable alternative to medical therapy in patients with microprolactinomas and prolactin below 200 micrograms/L.