Treatment Options for Prolactin (PRL)-Producing Pituitary Tumors

Treatment options for PRL-producing pituitary tumors include:

When the pituitary tumor secretes PRL, treatment depends on tumor size and the symptoms that result from excessive hormone production. Patients with PRL-secreting tumors are treated with surgery and radiation therapy.[1]

Most microprolactinomas and macroprolactinomas respond well to medical therapy with ergot-derived dopamine agonists, including bromocriptine and cabergoline.[2] For many patients, cabergoline has a more tolerable side effect profile than bromocriptine. Cabergoline therapy may be successful in treating patients whose prolactinomas are resistant to bromocriptine or who cannot tolerate bromocriptine, and this treatment has a success rate of more than 90% in patients with newly diagnosed prolactinomas.[3-5] In a prospective study, cabergoline was safely withdrawn in patients with normalized PRL levels and no evidence of tumor, which may produce a cure rate of approximately 70%.[6] Bromocriptine is the treatment of choice when the patient wants to preserve fertility because of its safety record in pregnancy.[7]

Microprolactinomas change little in size with treatment, but macroprolactinomas can shrink, sometimes quite dramatically. Microprolactinomas may decrease in size over time and they have occasionally been observed to undergo complete, spontaneous resolution.[8] Surgery is typically reserved for patients who cannot tolerate dopamine agonists, who suffer pituitary apoplexy during treatment, or whose macroprolactinomas are not responsive to medical therapy.[2] Occasionally, these tumors may require radiation therapy.[9]