How is a prolactinoma treated?
No treatment
Very occasionally, an endocrinologist will recommend that no treatment is given. This
will usually only be in the case of a very small tumor which is causing no ill effects.
In this case, regular follow-up visits will be scheduled. However, most people will be
given treatment.
Medical treatment
Whatever the size of your prolactinoma, it is likely that it will be treated with an oral
medication (tablets). The longest established tablet is called bromocriptine (brand name
Parlodel), but there are alternatives within the same group of medicines, including
cabergoline (brand name Dostinex) and pergolide (brand name Permax). These medications
decrease prolactin levels, often to normal. They usually cause the tumor to shrink and
improve any visual problems caused by the tumor. Smaller tumors may disappear completely
during treatment.
Which drug and in what dose?
Bromocriptine has been used for many years and is safe and well-tolerated, even during
pregnancy. It should be taken with meals to avoid nausea. The dose will be built up
gradually to avoid side effects, such as dizziness. The maintenance bromocriptine dose
for most people is one tablet (2.5mg) twice or three times a day. Sometimes the dose can
be reduced later during long-term treatment. Apart from the side effects mentioned above,
bromocriptine may occasionally cause constipation, but this is usually easy to deal with.
Cabergoline is in the same family of drugs as bromocriptine, but is longer-acting, so it
only requires one or two doses per week. It is just as effective as bromocriptine, and in
some cases more effective, and it can be taken by some people who cannot tolerate bromocriptine.
Pergolide is a different type of drug and is usually well-tolerated by people who cannot
take bromocriptine or cabergoline. It is usually taken once daily.
You will probably need to take these medications for a relatively long time, possibly
for ever. However, they will normally be stopped during pregnancy. If prolactin levels
return to normal, many endocrinologists stop treatment for a trial period of a few weeks
every few years or so to see if the medication can be stopped for a longer period of time.
Surgery and radiotherapy
These therapies are rarely used for prolactinomas. Surgery is usually only recommended
if medical treatment has failed (infrequently) or if you cannot tolerate the medications,
despite starting with low doses and increasing gradually. See surgery and radiotherapy for
further details if your endocrinologist says you need these treatments.
