From the Guidelines
Prolactinomas should be treated with cabergoline as the first-line therapy, as it has been shown to effectively reduce tumor size, normalize prolactin levels, and improve symptoms in most patients, according to the most recent consensus guideline 1. Prolactinomas cause symptoms through excessive prolactin production and by pressing on surrounding structures. Common symptoms include:
- Irregular or absent menstrual periods, infertility, and galactorrhea (inappropriate milk production) in women
- Decreased libido, erectile dysfunction, infertility, and sometimes breast enlargement or milk production in men
- Headaches, vision problems (particularly peripheral vision loss), and fatigue in both sexes Larger tumors can cause more severe headaches, significant visual impairment, and hormonal deficiencies affecting other pituitary functions. Diagnosis typically involves blood tests measuring prolactin levels and MRI imaging. Treatment options include dopamine agonist medications, with cabergoline being the preferred choice due to its better tolerability and efficacy, as demonstrated in a randomized controlled trial 1. Surgery may be necessary for patients who don't respond to medication or have severe visual impairment. Regular monitoring of prolactin levels and tumor size through imaging is essential for managing this condition effectively, as medication-induced shrinkage of prolactinomas can cause complications such as rhinorrhoea due to cerebrospinal fluid leak 1. It is also important to note that cabergoline has been shown to be effective in reducing tumor size by 80-88% and improving visual deficits in patients with prolactinomas, as reported in a recent study 1.
From the Research
Prolactinoma Symptoms
- The most common symptoms of prolactinoma in females include menstrual irregularity/amenorrhea, seen in 73.2% of females 2
- In males, the most common symptom is visual disturbance, seen in 80.6% of males 2
- Other symptoms may include galactorrhea, headache, and pituitary apoplexy
Treatment and Management
- Dopamine agonists, such as bromocriptine and cabergoline, are the primary treatment for prolactinomas 3, 4, 2
- Cabergoline is generally more effective than bromocriptine in normalizing prolactin levels and shrinking tumor size 3, 4, 2
- In cases of dopamine agonist resistance, other treatment options may include transsphenoidal neurosurgery, radiotherapy, and temozolomide 3, 5
Complications and Side Effects
- Dopamine agonists may cause side effects such as nausea, dizziness, and headache 4
- Rare but serious complications of dopamine agonist therapy include interstitial lung disease (ILD) and cardiac valvular fibrosis 6
- Patients on dopamine agonist therapy should be monitored for signs of ILD and cardiac valvular fibrosis, and echocardiographic monitoring is advised in patients on high doses of cabergoline 3, 6