Diagnosis and Medical Treatment of Prolactinomas(<SPECIAL ISSUE>Therapy for Tumors in Diencephalon and Pituitary)

Abstract

The first-line treatment of prolactinomas is medical therapy with dopamine receptor agonists. Bromocriptine (BC) has been used over the past 30 years, while cabergoline (CAB) is increasingly used in recent years because of its enhanced efficacy and better tolerability. Cabergoline is highly effective in normalizing elevated prolactin, recovering hypogonadism, and achieving a successful pregnancy in patients with tumoral and non-tumoral hyperprolactinemia. Also, CAB has a greater ability to shrink prolactinomas (PRLomas) than BC and often extinguishes them. Regarding the diagnosis, it requires demonstrating hyperprolactinemia on at least two separate occasions, excluding other causes of hyperprolactinemia than PRLomas, and detecting pituitary tumor on magnetic resonance imaging. Final diagnosis in non-operated cases is made empirically by attaining unequivocal tumor shrinkage or disappearance with CAB treatment.