Abstract
Prolactinoma is the most frequent pituitary tumor histotype. Men generally have macroadenomas whereas women generally have microadenomas. The major objectives of treating prolactinomas are to suppress excessive hormone secretion and its clinical consequences, to remove the tumor mass while preserving the residual pituitary function, and possibly to prevent disease recurrence or progression. Primary therapy of prolactinomas is based on use of dopamine-receptor agonists. Bromocriptine induces normalization of prolactin levels in 80–90% of patients with microprolactinomas and approximately 70% of those with macroprolactinomas. Tumor-mass shrinkage and improvement of visual-field defects are found in the majority of treated macroprolactinomas, but bromocriptine often causes side effects. Cabergoline is very effective and well tolerated in more than 90% of patients with either microprolactinomas or macroprolactinomas. Cabergoline treatment also induces tumor shrinkage in the majority of patients with macroprolactinomas. Tumor shrinkage is more evident if patients have not previously been treated with other dopamine agonists. Fewer results are available for men than for women, but there is no evidence that men are less responsive to dopamine agonists than are women.
Key Points
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Prolactinomas are the most common pituitary tumors in humans
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Microprolactinomas are more frequent than macroprolactinomas in women and are more frequent in the fertile age-group
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Bromocriptine has been used for longer than cabergoline and is effective in normalizing prolactin levels and in reducing tumor mass but more frequently induces side effects
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Cabergoline is a very efficient therapy for both macroadenomas and microadenomas
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Cabergoline withdrawal has a high success rate in patients with either microprolactinomas or macroprolactinomas if serial MRI scans during treatment show that the tumor has disappeared
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In men, cabergoline treatment restores erectile function and normalizes seminal-fluid characteristics
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Colao, A., Di Sarno, A., Guerra, E. et al. Drug Insight: cabergoline and bromocriptine in the treatment of hyperprolactinemia in men and women. Nat Rev Endocrinol 2, 200–210 (2006). https://doi.org/10.1038/ncpendmet0160
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DOI: https://doi.org/10.1038/ncpendmet0160
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