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A prolactinoma is a tumor of the pituitary gland that produces the hormone prolactin.It is the most common type of functioning pituitary tumor. [1] Symptoms of prolactinoma are due to abnormally high levels of prolactin in the blood (hyperprolactinemia), or due to pressure of the tumor on surrounding brain tissue and/or the optic nerves.
[1] [53] [54] A systematic review and meta-analysis has shown that cabergoline and quinagolide are more effective in the treatment of hyperprolactinemia compared to bromocriptine, [55] this is because evidence had suggested fewer side effects, rapid titration and offers better dosing interval in medication like quinagolide compared to ...
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Side effects are mostly dose dependent. Much more severe side effects are reported for treatment of Parkinson's disease and (off-label treatment) for restless leg syndrome which both typically require very high doses. The side effects are considered mild when used for treatment of hyperprolactinemia and other endocrine disorders or gynecologic ...
Dopamine agonists for infertility treatment are commonly administered to hyperprolactinemic anovulation patients. Both bromocriptine and cabergoline are the first-line dopamine agonist in hyperprolactinemia treatment. [46] Cabergoline is currently more preferred than bromocrptine due to its higher efficacy and fewer side effects like nausea. [53]
Medical therapy is a second line treatment, and thyrotropinomas respond to treatment with somatostatin receptor ligands such as octreotide or lanreotide. [68] In people with thyrotropinomas, treatment with somatostatin receptor ligands normalized thyroid hormone levels in 80-90% of people, and 42% of people had a decreased tumor size.
When symptoms are present, medical therapy is the treatment of choice. Patients with hyperprolactinemia and no symptoms (idiopathic or microprolactinoma) can be monitored without treatment. Consider treatment for women with amenorrhea. In addition, dual energy X-ray absorptiometry scanning should be considered to evaluate bone density.
Whereas D 2 receptor agonists suppress prolactin secretion, dopamine D 2 receptor antagonists like domperidone and metoclopramide have the opposite effect, strongly inducing the pituitary secretion of prolactin, and are sometimes used as prolactin releasers, for instance to correct hypoprolactinemia (low prolactin levels) in the treatment of lactation failure. [2]