How is a pituitary prolactinoma treated?

The treatment of pituitary prolactinoma troubles many patients. In fact, the treatment methods for different adenoma are also different, so we naturally cannot blindly deal with the treatment of microneme tumors. It is recommended to adopt medication or conservative treatment methods.

1. Treatment of microadenoma . Bromocriptine therapy is advocated, starting with a small dose, taken orally during meals or before bedtime to reduce nausea, vomiting, weakness, nasal congestion, positional hypotension and other reactions, and gradually increasing the dose. After 2 to 6 months of use, the patient's galactorrhea disappears, menstruation returns to normal, blood PRL levels drop to normal, adenoma shrinks, and conception and childbirth are possible. If the patient is indeed pregnant, bromocriptine can be discontinued immediately, but the clinical manifestations and visual fields should be checked regularly to see whether the pregnancy causes the adenoma to grow. Bromocriptine is currently considered to have no teratogenic effect. Generally, medication should be continued after delivery, but in 1/6 patients with pituitary PRL microadenomas, blood PRL levels remain normal after stopping bromocriptine. There are also reports in the literature of using other DA agonists, such as thioperidine and lisuride, to treat pituitary PRL tumors.

2. Treatment of macroadenoma. Bromocriptine can also be used to treat patients without severe perisellar compression. After the patient becomes pregnant, the medication is generally continued until delivery. If the drug is discontinued, the pregnancy must be closely monitored for any enlargement of the tumor. After long-term use of bromocriptine, the blood PRL level has dropped significantly, but has not returned to normal, and the patient still has symptoms. The dosage can be reduced but cannot be stopped. Patients with PRL macroadenomas who do not respond to bromocriptine may partially respond to the estrogen antagonist tamoxifen.

3. Surgical treatment

If the tumor is very large and there is obvious compression on the optic chiasm and hypothalamus, consider pituitary radiotherapy or even surgical treatment. Depending on the clinical situation, transsphenoidal or transfrontal approach for pituitary tumor resection can be selected. Currently, the cure rate of transsphenoidal surgery for invasive adenomas is only about 50%. Scholars believe that a period of treatment with bromocriptine before surgery can shrink the tumor and facilitate surgical removal. For patients with macroadenomas who wish to become pregnant, some scholars advocate giving them a course of pituitary radiotherapy first, with surgery or bromocriptine as the only adjuvant treatment.