Prolactinoma Treatment Overview

When to see a healthcare provider

See a healthcare provider if you have signs of prolactinoma, a noncancerous tumor of the pituitary gland. Symptoms include headache, impaired vision, irregular periods (women), and erectile dysfunction (men).

If untreated, the tumor can lead to serious complications like infertility, osteoporosis, seizures, and pituitary apoplexy (blockage of blood flow or bleeding in the pituitary gland). Your provider will also want to rule out conditions that cause similar symptoms, like hypothyroidism and kidney failure.

Getting diagnosed

Your healthcare provider can diagnose prolactinoma based on your symptoms and they may also use any of these tests:

• Blood tests to measure levels of the hormone prolactin
• Imaging tests—usually an MRI scan—to identify a prolactinoma, its size, and where it is located on the pituitary gland.
• If a prolactinoma is detected, your doctor will likely order additional hormone testing. The pituitary gland produces many hormones, and it is possible a tumor is affecting other hormones too.

What to expect from your doctor visit

• Prolactinoma is usually treated with medication called dopamine agonists, which can lower your production of prolactin, shrink the tumor, and treat your symptoms.
• In women with prolactinomas who are not planning on getting pregnant, estrogen and progesterone replacement is also an option. These do not usually help fertility, so they are not recommended if you want to become pregnant. For men, testosterone replacement is an option.
• If these medications don’t improve your symptoms, your doctor may recommend surgery. In most cases, the tumor is removed through the nose. But if the tumor is large or has spread to other areas, it may be removed through an opening in the skull (craniotomy). Unfortunately, symptoms often return after surgery because it is difficult to remove all of the abnormal cells.
• If a prolactinoma comes back, radiation therapy may be used to destroy tumor cells. It can also be used if the tumor is large, does not respond to medication, or you are  not able to have surgery.

Prescription prolactinoma medications

• Dopamine agonists: cabergoline (Dostinex), bromocriptine (Parlodel)

Types of prolactinoma providers

• A primary care provider can evaluate signs of a prolactinoma.
• Prolactinomas are most commonly treated by endocrinologists, who have special training in conditions that affect hormones.
• If surgery is necessary, you will be referred to either a neurosurgeon, who specializes in brain tumors, or an otolaryngological (ENT) surgeon, who specializes in head and neck tumors.