Standard Treatment Options for Prolactin (PRL)-Producing Pituitary Tumors
Standard treatment options for PRL-producing pituitary tumors include the following:
- Dopamine agonists, such as cabergoline and bromocriptine.[1,2,3,4,5]
- Surgery (second-line).[1,2]
- Radiation therapy (occasionally).[1,2]
When the pituitary tumor secretes PRL, treatment will depend on tumor size and the symptoms that result from excessive hormone production. Patients with PRL-secreting tumors are treated with surgery and radiation therapy.
Most microprolactinomas and macroprolactinomas respond well to medical therapy with ergot-derived dopamine agonists, including bromocriptine and cabergoline. For many patients, cabergoline has a more satisfactory side effect profile than bromocriptine. Cabergoline therapy may be successful in treating patients whose prolactinomas are resistant to bromocriptine or who cannot tolerate bromocriptine, and this treatment has a success rate of more than 90% in patients with newly diagnosed prolactinomas.[3,4,5] In a prospective study, cabergoline was safely withdrawn in patients with normalized prolactin levels and no evidence of tumor, which may effect a cure rate of approximately 70%. On the basis of its safety record in pregnancy, however, bromocriptine is the treatment of choice when restoration of fertility is the patient's goal.
Microprolactinomas change little in size with treatment, but macroprolactinomas can be expected to shrink, sometimes quite dramatically. Microprolactinomas may decrease in size over time and have been observed to undergo complete, spontaneous resolution on occasion. Surgery is typically reserved for those patients who cannot tolerate dopamine agonists, who suffer pituitary apoplexy during treatment, or whose macroprolactinomas are not responsive to medical therapy. Occasionally, these tumors may ultimately require radiation therapy.
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with pituitary tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
- Yeh PJ, Chen JW: Pituitary tumors: surgical and medical management. Surg Oncol 6 (2): 67-92, 1997.
- Levy A: Pituitary disease: presentation, diagnosis, and management. J Neurol Neurosurg Psychiatry 75 (Suppl 3): iii47-52, 2004.
- Colao A, Di Sarno A, Landi ML, et al.: Macroprolactinoma shrinkage during cabergoline treatment is greater in naive patients than in patients pretreated with other dopamine agonists: a prospective study in 110 patients. J Clin Endocrinol Metab 85 (6): 2247-52, 2000.
- Cannavò S, Curtò L, Squadrito S, et al.: Cabergoline: a first-choice treatment in patients with previously untreated prolactin-secreting pituitary adenoma. J Endocrinol Invest 22 (5): 354-9, 1999.
- Colao A, Di Sarno A, Landi ML, et al.: Long-term and low-dose treatment with cabergoline induces macroprolactinoma shrinkage. J Clin Endocrinol Metab 82 (11): 3574-9, 1997.
- Colao A, Di Sarno A, Cappabianca P, et al.: Withdrawal of long-term cabergoline therapy for tumoral and nontumoral hyperprolactinemia. N Engl J Med 349 (21): 2023-33, 2003.
- Schlechte JA: Clinical practice. Prolactinoma. N Engl J Med 349 (21): 2035-41, 2003.
- Ezzat S, Asa SL, Couldwell WT, et al.: The prevalence of pituitary adenomas: a systematic review. Cancer 101 (3): 613-9, 2004.
- Nomikos P, Buchfelder M, Fahlbusch R: Current management of prolactinomas. J Neurooncol 54 (2): 139-50, 2001.