title: Update on prolactinomas. Part 2: Treatment and management strategies.
abstract: The authors present an update on the various treatment modalities and discuss management strategies for prolactinomas. Prolactinomas are the most common type of functional pituitary tumor. Effective hyperprolactinemia treatment is of great importance, due to its potential deleterious effects including infertility, gonadal dysfunction and osteoporosis. Dopamine agonist therapy is the first line of treatment for prolactinomas because of its effectiveness in normalizing serum prolactin levels and shrinking tumor size. Though withdrawal of dopamine agonist treatment is safe and may be implemented following certain recommendations, recurrence of disease after cessation of the drug occurs in a substantial proportion of patients. Concerns regarding the safety of dopamine agonists have been raised, but its safety profile remains high, allowing its use during pregnancy. Surgery is typically indicated for patients who are resistant to medical therapy or intolerant of its adverse side effects, or are experiencing progressive tumor growth. Surgical resection can also be considered as a primary treatment for those with smaller focal tumors where a biochemical cure can be expected as an alternative to lifelong dopamine agonist treatment. Stereotactic radiosurgery also serves as an option for those refractory to medical and surgical therapy.
authors.affiliation: Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Suite 8100, 90 Bergen Street, Newark, NJ 07103, USA; Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA.
authors.forename: Anni
authors.initials: A
authors.lastname: Wong
authors.affiliation: Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Suite 8100, 90 Bergen Street, Newark, NJ 07103, USA; Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA; Department of Otolaryngology, Head and Neck Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA.
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
authors.forename: William T
authors.initials: WT
authors.lastname: Couldwell
authors.affiliation: Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Suite 8100, 90 Bergen Street, Newark, NJ 07103, USA; Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA; Department of Otolaryngology, Head and Neck Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA. Electronic address: james.liu.md@rutgers.edu.
authors.forename: James K
authors.initials: JK
authors.lastname: Liu
mesh_terms: D001971:Bromocriptine / Q000627:therapeutic use; D000077465:Cabergoline; D019468:Disease Management; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D019008:Drug Resistance, Neoplasm; D004873:Ergolines / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006966:Hyperprolactinemia / Q000097:blood / Q000209:etiology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D044583:Neuroendoscopy / Q000379:methods; D010911:Pituitary Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000628:therapy; D011388:Prolactin / Q000097:blood*; D015175:Prolactinoma / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D016634:Radiosurgery / Q000009:adverse effects; D013101:Sphenoid Sinus
chemical_list: D018491:Dopamine Agonists; D004873:Ergolines; D001971:Bromocriptine; D011388:Prolactin; D000077465:Cabergoline
keywords: Bromocriptine; Cabergoline; Dopamine agonist; Endoscopic endonasal transsphenoidal surgery; Pituitary tumor; Prolactinomas; Radiosurgery