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Surgical treatment of prolactinomas: cons

  • Pros and Cons in Endocrine Practice
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Abstract

Prolactinomas account for approximately 40 % of all pituitary adenomas. Over 95 % of prolactinomas are microadenomas (< 10 mm diameter). Treatment is indicated to correct hypogonadism, restore other hormonal deficits, and alleviate local mass effects. Dopamine agonists (DA) are highly effective in achieving these goals and are well-tolerated. The vast majority of prolactinomas will respond to conventional doses of cabergoline (≤2 mg/week) that do not carry an increased risk of cardiac valvular abnormalities. DA therapy may be successful withdrawn in a subset of patients and thus is not necessarily a lifelong commitment. Although transsphenoidal surgery (TSS) is an option for prolactinoma treatment, it is less effective than medical management, carries considerably more risk, and is more expensive. The benefit/risk ratio for DA therapy compared to TSS actually becomes increasingly more favorable as tumor size increases. Therefore DA should remain the clear treatment of choice for essentially all patients with prolactinomas, reserving TSS as a second-line option for the very small number of patients that do not tolerate or are completely resistant to DA therapy.

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Conflict of interest

All medications discussed are currently generic. However, MEM has received research support in the past from Novartis and Pfizer for the conduct of studies with bromocriptine and cabergoline.

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  1. Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, 645 N. Michigan Ave., Suite 530, Chicago, IL, 60611, USA

    Eve Bloomgarden & Mark E. Molitch

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  1. Eve Bloomgarden
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  2. Mark E. Molitch
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Correspondence to Mark E. Molitch.

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Bloomgarden, E., Molitch, M.E. Surgical treatment of prolactinomas: cons. Endocrine 47, 730–733 (2014). https://doi.org/10.1007/s12020-014-0369-9

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