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Treatment of prolactinomas
A Colao1, L Annunziato, G Lombardi
1Department of Molecular and Clinical Endocrinology and Oncology, Federico II University, Naples, Italy. rpivone@tin.it
Annals of Medicine
|November 14, 1998
Summary
Pharmacotherapy with dopamine agonists is the preferred first-line treatment for hyperprolactinaemia, effectively suppressing prolactin (PRL) and shrinking tumors. Surgery is reserved for patients intolerant or resistant to these medications.
Area of Science:
- Endocrinology
- Neurosurgery
Background:
- Hyperprolactinaemia treatment aims to reduce prolactin (PRL) secretion, manage clinical effects, and prevent recurrence.
- Historically, treatment involved surgery or irradiation, with varying success rates for micro- and macroprolactinomas.
Purpose of the Study:
- To evaluate the efficacy of pharmacotherapy versus surgery for hyperprolactinaemia.
- To establish optimal treatment strategies for micro- and macroprolactinomas.
Main Methods:
- Review of treatment outcomes for trans-sphenoidal surgery in micro- and macroprolactinomas.
- Analysis of pharmacotherapy efficacy using bromocriptine and cabergoline for prolactinoma management.
Main Results:
- Trans-sphenoidal surgery normalizes PRL in 35-70% of microprolactinomas and 32% of macroprolactinomas, with recurrence rates up to 19%.
- Bromocriptine (2.5-5 mg/day) suppresses PRL and shrinks tumors in over 80% of microprolactinomas, though side effects occur in 5-10%.
- Cabergoline (0.5-2 mg/week) effectively normalizes PRL and reduces tumor size in most patients.
Conclusions:
- Dopamine agonist pharmacotherapy is the recommended first-line treatment for both micro- and macroprolactinomas.
- Surgery is indicated for patients with severe intolerance or resistance to dopamine agonists.