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Treatments and drugs
By Mayo Clinic staffSpecific goals in the treatment of prolactinoma include:
- Return the production of prolactin to normal levels
- Restore normal pituitary gland function
- Eliminate galactorrhea
- Reduce the size of the pituitary tumor
- Eliminate any signs or symptoms from tumor pressure, such as headaches or vision problems
Prolactinoma treatment consists of two main therapies, medications and surgery:
Medications
Oral medications often can decrease the production of prolactin and eliminate symptoms. Medications may also shrink the tumor. However, long-term treatment with medications is generally necessary.
Doctors use drugs known as dopamine agonists to treat prolactinoma. These drugs mimic the effects of dopamine — the brain chemical that normally controls prolactin production — but are much more potent and long lasting. Commonly prescribed medications include bromocriptine (Parlodel) and cabergoline (Dostinex). These drugs decrease prolactin production and may shrink the tumor in most people with prolactinoma.
Bromocriptine is the preferred drug when treating women who want to restore their fertility because its safety in pregnancy is well established. Common side effects of these medications include lightheadedness, nausea and nasal stuffiness. However, these side effects often can be minimized if your doctor starts you with a very low dose of medication and gradually increases the dose.
If medication effectively shrinks the tumor and your prolactin level remains normal afterward, you may be able to eventually stop taking the medication. Your doctor can offer you advice on when this may be possible for you.
Surgery
If drug therapy for the treatment of prolactinoma is unsuccessful or not tolerated, surgery may be an option for the removal of a pituitary tumor. It may also be necessary to relieve pressure on the nerves that control your vision.
The type of surgery you have depends largely on the location and the size of your tumor. Most people who need surgery have a transsphenoidal procedure. In this surgery, the tumor is removed through the nasal cavity. Complication rates from this type of surgery are low because no other areas of the brain are touched during surgery, and this surgery leaves no visible scars. However, transsphenoidal surgery may not be best for some large tumors, or for tumors that have spread to nearby brain tissue. If this is the case for you, you may need a transcranial procedure, also known as a craniotomy. This procedure involves accessing the tumor through the upper part of the skull.
The outcome of surgery depends on the size and location of the tumor and if your prolactin level is extremely high. The higher the prolactin level, the slimmer the chance that your prolactin production will return to normal after surgery. Surgery corrects the prolactin level in most people with small pituitary tumors. However, many pituitary tumors recur within five years after surgical removal. For people with larger tumors that can only be partially removed, drug therapy often can return the prolactin level to a normal range after surgery.
