From the Guidelines
You should not start hormone replacement therapy (HRT) without first consulting an endocrinologist and treating the suspected prolactinoma. Prolactinomas are pituitary tumors that produce excess prolactin, which can interfere with hormone production and potentially grow in response to estrogen 1. The standard approach for prolactinomas is typically to treat the tumor first with medications like cabergoline, which reduce prolactin levels and often shrink the tumor 1. Some key points to consider include:
- Cabergoline is the dopamine agonist of choice for treating prolactinomas due to its superior effectiveness and lower adverse effect profile 1.
- Treatment with cabergoline can induce normalization of prolactin levels, tumour shrinkage, and resolution of symptoms such as visual field defects, galactorrhoea, and sexual dysfunction 1.
- Estrogen could potentially stimulate tumor growth in some cases, making it essential to control the prolactinoma before initiating HRT 1.
- Your endocrinologist may need to coordinate with your hormone prescriber to develop a safe treatment plan that addresses both conditions appropriately. It is crucial to prioritize treating the prolactinoma before starting HRT to minimize potential risks and ensure the best possible outcome for morbidity, mortality, and quality of life.
From the Research
Suspected Prolactinoma and HRT
- A suspected prolactinoma is a condition that requires medical attention, and the decision to start Hormone Replacement Therapy (HRT) should be made under the guidance of a healthcare professional 2, 3, 4, 5.
- The primary treatment for prolactinomas is dopamine agonists, which can help reduce prolactin levels and shrink the tumor 2, 3, 4, 5.
- HRT may be considered in some cases, but it is essential to weigh the benefits and risks, particularly in patients with macroadenomas, as tumor growth is a concern 3, 5.
- Estrogen replacement therapy may decrease the efficacy of dopamine agonists, and alternative approaches, such as selective estrogen receptor modulators or aromatase inhibitors, may be considered 3.
Treatment Options for Prolactinoma
- Dopamine agonists, such as bromocriptine and cabergoline, are the primary treatment for prolactinomas 2, 3, 4, 5.
- Transsphenoidal surgery may be considered for patients who are resistant to dopamine agonists or have aggressive tumors 3, 4, 5.
- Radiotherapy and temozolomide may be options for patients with aggressive or malignant prolactinomas 3, 4, 5.
Considerations for HRT in Prolactinoma Patients
- The decision to start HRT should be made on a case-by-case basis, taking into account the individual's medical history, tumor size, and response to dopamine agonists 3, 5.
- Close monitoring of prolactin levels and tumor size is essential for patients on HRT 2, 3, 4, 5.
- Patients should be aware of the potential risks and benefits of HRT and dopamine agonists, including the risk of impulse control disorders associated with dopamine agonists 6.