Goals in the treatment of prolactinoma include:
- Return the production of prolactin to normal levels
- Restore normal pituitary gland function
- Eliminate galactorrhea
- Reduce the size of the pituitary tumor
- Eliminate any signs or symptoms from tumor pressure, such as headaches or vision problems
Prolactinoma treatment consists of two main therapies, medications and surgery:
Oral medications often can decrease the production of prolactin and eliminate symptoms. Medications may also shrink the tumor. However, long-term treatment with medications is generally necessary.
Doctors use drugs known as dopamine agonists to treat prolactinoma. These drugs mimic the effects of dopamine — the brain chemical that normally controls prolactin production — but are much more potent and long lasting. Commonly prescribed medications include bromocriptine (Cycloset, Parlodel) and cabergoline. These drugs decrease prolactin production and may shrink the tumor in most people with prolactinoma.
Medication during pregnancy. Bromocriptine is the preferred drug when treating women who want to restore their fertility because its safety in pregnancy is well established. During pregnancy, your doctor will likely advise you to stop taking bromocriptine or carbergoline.
Although these medications are considered safe in pregnancy, doctors generally prefer to keep medications to a minimum while you're pregnant. However, if you have a very large tumor, your doctor may recommend that you continue to take your medication during your pregnancy to prevent complications from the prolactinoma. If you're being treated for prolactinoma and you'd like to start a family, it's best to discuss your options with your doctor before you become pregnant.
- Common side effects. Lightheadedness, nausea and nasal stuffiness are common side effects of these medications. However, these side effects often can be minimized if your doctor starts you with a very low dose of medication and gradually increases the dose. Cabergoline has less frequent and less severe side effects, but it's more expensive than bromocriptine and newer, so its long-term safety record isn't as well established. There have been rare cases of heart valve damage with cabergoline. Some people may also develop compulsive behaviors, such as gambling, while taking these medications.
If medication effectively shrinks the tumor and your prolactin level remains normal for two years afterward, you may be able eventually to stop taking the medication. Your doctor can offer you advice on when this may be possible for you. However, don't stop taking either drug without your doctor's approval.
If drug therapy for the treatment of prolactinoma doesn't work or you can't tolerate the medication, surgery may be an option for the removal of a pituitary tumor. It may also be necessary to relieve pressure on the nerves that control your vision.
The type of surgery you have depends largely on the size and extent of your tumor:
- Transsphenoidal surgery. Most people who need surgery have a transsphenoidal procedure. In this surgery, the tumor is removed through the nasal cavity. Complication rates from this type of surgery are low because no other areas of the brain are touched during surgery, and this surgery leaves no visible scars.
- Transcranial surgery. If your tumor is large or has spread to nearby brain tissue, you may need a transcranial procedure, also known as a craniotomy. This procedure involves accessing the tumor through the upper part of the skull.
The outcome of surgery depends on the size and location of the tumor and your prolactin levels before surgery. The higher the prolactin level, the slimmer the chance that your prolactin production will return to normal after surgery. Surgery corrects the prolactin level in most people with small pituitary tumors. However, many pituitary tumors come back within five years of surgery. For people with larger tumors that can only be partially removed, drug therapy often can return the prolactin level to a normal range after surgery.
For people who don't respond to medication and aren't candidates for surgery, radiation therapy may be an option.
Nov. 30, 2012
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