Prolactinoma - Is treatment always necessary?

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Small prolactinomas rarely increase in size so it is not necessary to treat with cabergoline or bromocriptine to prevent tumor growth. It is important, however, to maintain normal estrogen and testosterone levels to avoid low levels of key sex steroids, and to prevent bone loss. When pregnancy is not an issue, your doctor may recommend treatment with estrogen or testosterone instead of bromocriptine or cabergoline. Estrogen therapy in women and testosterone therapy in men is safe and well tolerated and will help prevent premature bone loss.

Prolactin levels should also be monitored during therapy with estrogen or testosterone. An increase in the size of a prolactinoma is usually preceded by a substantial increase in prolactin level so it is not necessary to do regular MRI scans unless your prolactin level increases markedly or you develop headaches or prominent visual changes.