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  • Review Article
  • Published:

Medical treatment of prolactinomas

Nature Reviews Endocrinology volume 7, pages 267–278 (2011)Cite this article

Subjects

Abstract

Prolactinomas, the most prevalent type of neuroendocrine disease, account for approximately 40% of all pituitary adenomas. The most important clinical problems associated with prolactinomas are hypogonadism, infertility and hyposexuality. In patients with macroprolactinomas, mass effects, including visual field defects, headaches and neurological disturbances, can also occur. The objectives of therapy are normalization of prolactin levels, to restore eugonadism, and reduction of tumor mass, both of which can be achieved in the majority of patients by treatment with dopamine agonists. Given their association with minimal morbidity, these drugs currently represent the mainstay of treatment for prolactinomas. Novel data indicate that these agents can be successfully withdrawn in a subset of patients after normalization of prolactin levels and tumor disappearance, which suggests the possibility that medical therapy may not be required throughout life. Nevertheless, multimodal therapy that involves surgery, radiotherapy or both may be necessary in some cases, such as patients who are resistant to the effects of dopamine agonists or for those with atypical prolactinomas. This Review reports on efficacy and safety of pharmacotherapy in patients with prolactinomas.

Key Points

  • Medical treatment of prolactinomas with cabergoline, quinagolide or bromocriptine is very efficacious; cabergoline has demonstrated superiority in efficacy to other drugs in many studies

  • Cardiac valve disease induced by cabergoline treatment in patients with hyperprolactinemia is still a matter of debate

  • In the absence of unequivocal proof excluding a negative effect of cabergoline in patients with hyperprolactinemia, all patients who receive long-term cabergoline treatment should undergo regular echocardiographic follow-up

  • Long-term discontinuation of cabergoline or bromocriptine in patients with hyperprolactinemia of any cause has shown a variable rate of tumor recurrence; predictors of recurrence before cabergoline withdrawal are tumor diameter and prolactin levels

  • Resistance to dopamine agonists is a rare phenomenon that characterizes a group of tumors that generally manifest with a more aggressive behavior than usual

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Figure 1: Prevalence of normal prolactin levels and of tumor shrinkage >80% compared to basal volume in patients with macroprolactinomas grouped according to previous treatment with bromocriptine or quinagolide and then treated with cabergoline (0.25–3.5 mg weekly) for 1–3 years.
Figure 2: Prevalence of valve regurgitation in patients with hyperprolactinemia treated with cabergoline for a median period of 74 months.
Figure 3: Kaplan-Meier estimation of recurrence of hyperprolactinemia after 10 years of cabergoline withdrawal.
Figure 4: Correlation analysis of data obtained by 227 patients included in the study by Colao and colleagues80

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  1. Department of Molecular and Clinical Endocrinology and Oncology, University Federico II of Naples, Italy, Via Sergio Pansini 5, I-80131, Naples, Italy

    Annamaria Colao & Silvia Savastano

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  1. Annamaria Colao
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S. Savastano researched the data for the article and provided substantial contributions to discussions of the content. A. Colao wrote the article and reviewed and/or edited the manuscript before submission.

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Correspondence to Annamaria Colao.

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Colao, A., Savastano, S. Medical treatment of prolactinomas. Nat Rev Endocrinol 7, 267–278 (2011). https://doi.org/10.1038/nrendo.2011.37

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