From the Guidelines
Prolactin levels can be effectively decreased in patients with prolactinoma through the use of dopamine agonists, with cabergoline being the preferred choice due to its superior effectiveness and lower adverse effect profile. The primary treatment approach for prolactinoma involves the use of dopamine agonists, which work by activating dopamine receptors that inhibit prolactin secretion 1.
Treatment Options
- Dopamine agonists, such as cabergoline, are the first-line therapy for reducing serum prolactin concentrations and inducing tumor shrinkage in patients with prolactinoma 1.
- Cabergoline is preferred over other dopamine agonists due to its superior effectiveness and lower adverse effect profile 1.
Key Considerations
- The treatment of prolactinoma is focused on reducing prolactin levels and tumor size, with the goal of improving symptoms and quality of life.
- Regular monitoring of prolactin levels is essential to assess treatment effectiveness and adjust the treatment plan as needed.
- While surgery and radiation therapy are also options for treating prolactinoma, dopamine agonists are generally the first-line treatment due to their effectiveness and safety profile 1.
From the FDA Drug Label
Bromocriptine mesylate significantly reduces plasma levels of prolactin in patients with physiologically elevated prolactin as well as in patients with hyperprolactinemia. Bromocriptine mesylate tablets, USP are indicated for the treatment of dysfunctions associated with hyperprolactinemia including amenorrhea with or without galactorrhea, infertility or hypogonadism Bromocriptine mesylate tablets, USP treatment is indicated in patients with prolactin-secreting adenomas, which may be the basic underlying endocrinopathy contributing to the above clinical presentations. Reduction in tumor size has been demonstrated in both male and female patients with macroadenomas
Yes, prolactin can be decreased in prolactinoma. Bromocriptine mesylate is a dopamine receptor agonist that reduces plasma levels of prolactin in patients with hyperprolactinemia, including those with prolactin-secreting adenomas. The treatment is indicated for the treatment of dysfunctions associated with hyperprolactinemia, including amenorrhea, galactorrhea, infertility, and hypogonadism. Reduction in tumor size has been demonstrated in both male and female patients with macroadenomas 2, 2, 2.
From the Research
Prolactinoma Treatment
Prolactin levels can be decreased in prolactinoma using various treatment options. The primary treatment for prolactinoma is based on the use of dopamine agonists (DAs) such as bromocriptine, lisuride, quinagolide, and cabergoline 3, 4, 5.
Dopamine Agonists
- Dopamine agonists induce normal prolactinemia and ovulatory cycles in over 80% of cases 3.
- Cabergoline is the preferred treatment for micro- and macroprolactinomas due to its effectiveness in normalizing prolactin levels and reducing tumor size, as well as its fewer side effects compared to bromocriptine 4, 5.
- Bromocriptine induces normalization of prolactin levels in 80-90% of patients with microprolactinomas and approximately 70% of those with macroprolactinomas 5.
Treatment Outcomes
- A significant reduction in prolactin levels can be seen within six to 12 months of treatment with dopamine agonists 6.
- Tumor size can also be reduced with medical management, with a notable decrease in adenoma size seen in patients treated with cabergoline 6.
- Complete resolution of adenoma can occur in some patients, with 13 patients in one study experiencing complete resolution of their adenoma 6.
Resistance to Dopamine Agonists
- In cases where patients are resistant to dopamine agonists, alternative treatments such as somatostatin analogs may be effective 7.
- The addition of octreotide LAR to ongoing cabergoline treatment may result in a significant reduction in prolactin concentrations and adenoma size in some patients with dopamine agonist-resistant macroprolactinomas 7.