Prolactinoma (cont.)

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How is a prolactinoma treated?

Prolactinomas are usually initially treated with medications.

Surgery is considered if the medications cannot be tolerated, or if they are not effective.

The medical treatment may be only partially successful. In such cases, the medications may be combined with surgery or radiation therapy.

What medications are used to treat prolactinomas?

Because dopamine is the chemical in the brain that normally inhibits prolactin secretion, doctors may treat prolactinomas with drugs that act like dopamine such as bromocriptine (Parlodel) or cabergoline (Dostinex). Both bromocriptine (Parlodel) and cabergoline (Dostinex) have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of hyperprolactinemia (high blood prolactin levels). Bromocriptine (Parlodel) is also approved for the treatment of infertility. Treatment with these drugs is successful in shrinking the tumor and returning prolactin levels to normal in approximately 80% of cases, or four out of every five patients.

Bromocriptine (Parlodel) is associated with side effects such as nausea and dizziness. To avoid these side effects, it is important that the dose of bromocriptine be increased slowly. Transvaginal use of bromocriptine is documented as a safe alternative route for delivery if nausea is excessive. In general, side effects typically disappear while the drug continues to lower prolactin levels.

Bromocriptine (Parlodel) treatment should not be interrupted without consulting a qualified endocrinologist. Prolactin levels often rise again in most people when the drug is discontinued. In some, however, prolactin levels remain normal, so the doctor may suggest reducing or discontinuing treatment every two years on a trial basis.

Cabergoline (Dostinex) is also associated with side effects such as nausea and dizziness, but these effects are usually less common and less severe than with bromocriptine. As with bromocriptine therapy, side effects may be avoided if treatment is started gradually. Recently, the use of Dostinex has been linked to heart valve problems. Many endocrinologists are using Dostinex as a last resort if bromocriptine simply cannot be tolerated.

If side effects develop with a higher dose, the doctor may return to the previous dosage. If a patient's prolactin blood level remains normal for six months, the doctor might consider stopping treatment.

Medical therapy can often shrink a prolactinoma such that surgery is not required.

Medically Reviewed by a Doctor on 12/20/2013

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