From the Guidelines
The initial treatment for a pituitary adenoma with hyperprolactinemia should be cabergoline, a dopamine agonist that effectively reduces prolactin secretion and typically shrinks prolactinomas. This recommendation is based on the most recent and highest quality evidence, which suggests that cabergoline is the dopamine agonist of choice due to its superior effectiveness and lower adverse effect profile 1. The standard starting dose of cabergoline is 0.25 mg twice weekly, which can be gradually increased if needed based on prolactin levels and symptom response.
Key Points to Consider
- Cabergoline has a longer half-life and greater affinity for the dopamine receptor than other dopamine agonists, making it a preferred option 1.
- Medical therapy with dopamine agonists is the first-line approach for prolactinomas, even before considering surgical intervention, as these tumors respond exceptionally well to dopamine agonists.
- Regular monitoring of prolactin levels and periodic imaging are necessary to assess treatment response and adjust the dose of cabergoline as needed.
- Surgery or radiation therapy would be considered only if the patient is intolerant to medical therapy or if the tumor is resistant to dopamine agonists.
Benefits of Cabergoline
- Reduces pituitary-origin hyperprolactinaemia of any cause
- Induces normalization of the prolactin level in a significant percentage of patients
- Causes tumour shrinkage in a majority of patients
- Resolves visual field defects, normalizes menses, fertility, and sexual function, and resolves galactorrhoea in a significant percentage of patients 1.
From the FDA Drug Label
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.
The initial treatment for a pituitary adenoma with hyperprolactinemia is bromocriptine mesylate tablets, USP. This treatment may help reduce tumor size in patients with macroadenomas and can be used prior to surgery if adenectomy is elected 2.
- Key benefits of bromocriptine mesylate tablets, USP include reduction in tumor size and improvement in clinical presentations associated with hyperprolactinemia.
From the Research
Initial Treatment for Pituitary Adenoma with Hyperprolactinemia
The initial treatment for a pituitary adenoma with hyperprolactinemia typically involves medical therapy.
- Dopamine agonists, such as cabergoline and bromocriptine, are commonly used as the first-line treatment for prolactinomas, which are pituitary adenomas that secrete prolactin 3, 4, 5, 6, 7.
- These medications work by stimulating dopamine receptors in the brain, which helps to decrease prolactin production and reduce tumor size.
- Cabergoline is often preferred over bromocriptine due to its longer half-life, higher efficacy, and better tolerability 3, 4.
- In some cases, surgical resection of the pituitary adenoma may be necessary, especially if the tumor is large or if medical therapy is not effective 3, 5, 7.
- Radiotherapy may also be considered in certain cases, such as when surgery is not possible or when the tumor is resistant to medical therapy 3.
Benefits of Dopamine Agonists
The use of dopamine agonists, such as cabergoline and bromocriptine, has several benefits, including:
- Normalization of prolactin levels and gonadal function 3, 4
- Reduction in tumor size 3, 4
- Improvement in symptoms such as galactorrhea, amenorrhea, and infertility 3, 4
- Good safety profile, especially for cabergoline and quinagolide 3, 4
Monitoring and Follow-up
Regular monitoring and follow-up are essential for patients with pituitary adenomas, including: