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Prolactinomas: Diagnosis and Management
Book chapter

Prolactinomas: Diagnosis and Management

Amal Shibli-Rahhal and Janet A Schlechte
Diagnosis and Management of Pituitary Disorders, pp.125-140
Contemporary Endocrinology, Humana Press
2008
DOI: 10.1007/978-1-59745-264-9_6

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Abstract

Prolactin-secreting adenomas account for 40% of all pituitary tumors and are classified as microadenomas (<10mm) and macroadenomas (>10mm). Microprolactinomas are more common in women and most women present with menstrual dysfunction, infertility or galactorrhea. Men commonly present with large tumors and although prolactinomas in men lead to hypogonadism, most men seek medical attention because of headaches or neurologic deficits. After ruling out secondary causes of hyperprolactinemia, the diagnosis of a prolactinoma is established with an elevated serum prolactin and radiographic evidence of a pituitary tumor. The treatment of choice for all prolactinomas is a dopamine agonist, and the goals of therapy are to normalize prolactin, restore gonadal function and fertility, reduce tumor size and reverse pituitary dysfunction. Bromocriptine and cabergoline are the two dopamine agonists used in the United States for treatment of prolactinomas and both are effective in normalizing prolactin and decreasing tumor size. Cabergoline is more potent, has fewer side effects and can be given twice weekly. Transsphenoidal surgery may be necessary in patients who do not respond to or are intolerant of dopamine agonists. Radiation therapy may be necessary in patients with large tumors who fail to respond to medical or surgical treatment.
 Prolactinoma Bromocriptine Dopamine agonist Cabergoline

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