TREATMENTS &
RESEARCH
latest
treatment
information
here.
Dr. Huntley's
Diagnosis
Checklist
See what questions
a doctor would ask.
Treatments for Prolactinoma
Treatments for Prolactinoma
The list of treatments mentioned in various sources for Prolactinoma includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.
- Dopamine agonists
- Surgical tumor removal
- Treatments to restore bone mass and prevent osteoporosis
Prolactinoma: Is the Diagnosis Correct?
The first step in getting correct treatment is to get a correct diagnosis. Differential diagnosis list for Prolactinoma may include:
Prolactinoma: Marketplace Products, Discounts & Offers
Products, offers and promotion categories available for Prolactinoma:
Prolactinoma: Research Doctors & Specialists
- Pregnancy & Fertility Health Specialists:
- Womens Health Specialists:
- Cancer Specialists:
- more specialists...»
Research all specialists including ratings, affiliations, and sanctions.
Hospitals & Medical Clinics: Prolactinoma
Research quality ratings and patient incidents/safety measures for hospitals and medical facilities in specialties related to Prolactinoma:
- Cancer (Oncology) -- Hospital Quality Ratings
- Womens Health -- Hospital Quality Ratings
- more hospital ratings...»
Hospital & Clinic quality ratings » »
Choosing the Best Treatment Hospital: More general information, not necessarily in relation to Prolactinoma, on hospital and medical facility performance and surgical care quality:
- 50 Best Hospitals Report
- Women's Health Best Hospitals
- Patient Safety
- Hospital Quality and Clinical Excellence Study (2009)
Discussion of treatments for Prolactinoma:
Medical TreatmentThe goal of treatment is to return prolactin secretion to normal, reduce tumor size, correct any visual abnormalities, and restore normal pituitary function. In the case of very large tumors, only partial achievement of this goal may be possible. Because dopamine is the chemical that normally inhibits prolactin secretion, doctors may treat prolactinoma with bromocriptine or cabergoline, drugs that act like dopamine. This type of drug is called a dopamine agonist. These drugs shrink the tumor and return prolactin levels to normal in approximately 80 percent of patients. Both have been approved by the Food and Drug Administration for the treatment of hyperprolactinemia. Bromocriptine is the only dopamine agonist approved for the treatment of infertility. Another dopamine agonist, pergolide, is available in the U.S., but is not approved for treating conditions that cause high blood levels of prolactin.
Bromocriptine is associated with side effects such as nausea and dizziness. To avoid these side effects, it is important for bromocriptine treatment to start slowly. An example of a typical approach used by an experienced endocrinologist follows:
Begin by taking a quarter of a 2.5 milligram tablet of bromocriptine with a snack at bedtime. After 3 days, increase the dose to a quarter of a tablet with breakfast and a quarter at bedtime. After 3 more days, take half a tablet twice a day, and 3 days later, one tablet at night and half with breakfast. Finally, the dose is increased to one tablet twice a day. If prolactin is still high, add half a tablet with lunch. If the medication is well tolerated, increase the dose to a full tablet. If side effects develop with a higher dose, return to the previous dosage. With time, side effects disappear while the drug continues to lower prolactin.
Bromocriptine treatment should not be interrupted without consulting a qualified endocrinologist. Prolactin levels often rise again in most people when the drug is discontinued. In some, however, prolactin levels remain normal, so the doctor may suggest reducing or discontinuing treatment every two years on a trial basis.
Cabergoline is also associated with side effects such as nausea and
dizziness, but these may be less common and less severe than with
bromocriptine. As with bromocriptine therapy, side effects may be avoided
if treatment is started slowly. An example of a typical approach used by
an experienced endocrinologist follows:
- Begin by taking .25 milligrams (or 1/2 tablet) twice a week. After
four weeks, increase the dose by .25 milligrams to .50 milligrams (or 1
tablet) twice a week. After four more weeks, increase the dose by .25
milligrams to .75 milligrams (or 1 1/2 tablets) twice a week. Finally,
after four additional weeks, the dose can be increased to 1 milligram
(or 2 tablets) twice a week. If side effects develop with a higher dose,
the doctor may return to the previous dosage. If a patient's prolactin
level remains normal for 6 months, a doctor may consider stopping
treatment.
Cabergoline should not be interrupted without consulting a qualified endocrinologist.
Surgery
Surgery should be considered if medical
therapy cannot be tolerated or if it fails to reduce prolactin levels,
restore normal reproduction and pituitary function, and reduce tumor size.
If medical therapy is only partially successful, this therapy should
continue, possibly combined with surgery or radiation.
The results of surgery depend a great deal on tumor size and prolactin level as well as the skill and experience of the neurosurgeon. The higher the prolactin level, the lower the chance of normalizing serum prolactin. In the best medical centers, surgery corrects prolactin levels in 80 percent of patients with a serum prolactin less than 250 ng/ml. Even in patients with large tumors that cannot be completely removed, drug therapy may be able to return serum prolactin to the normal range after surgery. Depending on the size of the tumor and how much of it is removed, studies show that 20 to 50 percent will recur, usually within five years.
How do I choose a skilled neurosurgeon?
Because the
results of surgery are so dependent on the skill and knowledge of the
neurosurgeon, a patient should ask the surgeon about the number of
operations he or she has performed to remove pituitary tumors, and for
success and complication rates in comparison to major medical centers. The
best results come from surgeons who have performed many hundreds or even
thousands of such operations.
(Source: excerpt from Prolactinoma: NIDDK)
Book Excerpts: Treatment of Prolactinoma
- Treatment - Amenorrhea
- Treatment - Amenorrhea – Primary
- Treatment - Amenorrhea – Secondary
- Treatment - Galactorrhea
- Treatment - Amenorrhea
- Patient counseling - Nipple discharge
- Patient counseling - Amenorrhea
- Patient counseling - Nipple discharge
- Patient counseling - Amenorrhea
- Nursing considerations - Nipple discharge
- Nursing considerations - Amenorrhea
Treatments of Prolactinoma: Online Medical Books
16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the treatments of Prolactinoma.
Amenorrhea:
Treatment
(In a Page: Signs and Symptoms)
- Imperforate hymen requires surgical correction
- Androgen insensitivity syndrome: Excise testes after puberty because of increased risk of testicular cancer
- Absent müllerian structure or presence of Y chromosome: Psychological counseling
- Ovarian failure: Consider hormone replacement therapy
-
Polycystic ovarian syndrome
–Oral contraceptives decrease ovarian androgen secretion
–Weight reduction decreases peripheral estrogen
–Clomiphene to enhance fertility
–Cyclic progesterone prevents endometrial hyperplasia -
Functional hypothalamic amenorrhea
–Weight gain and reduction in intensity of exercise
–Consider oral contraceptives to prevent osteoporosis
–Exogenous gonadotropins or pulsatile GnRH may be necessary
Source: In a Page: Signs and Symptoms, 2004
Amenorrhea – Primary:
Treatment
(In A Page: Pediatric Signs and Symptoms)
- Underlying chronic illnesses, malnourished states, or hypothyroidism should be treated
- Stop medications causing hyperprolactinemia (e.g., antidepressants, phenothiazines) if safe to do so
- Prolactinomas can be treated medically with a dopamine agonist
- Other pituitary tumors will need treatment according to their specific type
- Patients with ovarian insufficiency or hypogonadotropic hypogonadism need estrogen therapy for breast development, and then should cycle estrogens and progestins to establish menses