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Management of resistant prolactinomas

Nature Clinical Practice Endocrinology & Metabolism volume 2, pages 552–561 (2006)Cite this article

Abstract

Resistance to dopamine agonists occurs in a subset of patients with prolactin-secreting pituitary tumors. The resistance is mediated by loss of pituitary D2 receptors and occurs in both microadenomas and macroadenomas. Cabergoline is the most effective dopamine agonist and tumors that do not respond to bromocriptine or quinagolide frequently respond to cabergoline. Treatment options include maximizing the dose of the dopamine agonist, changing agonists, trans-sphenoidal surgery and radiation therapy. The goal of therapy is to restore and maintain gonadal and neurologic function, and this might occur in the absence of a normal prolactin level or a significant change in tumor size. Trans-sphenoidal pituitary surgery should be reserved for patients who are intolerant of medical therapy, or in whom this has failed. Radiation therapy has a limited role in treatment of resistant prolactinomas and should be reserved for patients in whom medical and surgical therapy has failed.

Key Points

  • 10–20% of patients with microprolactinomas and 20–30% of patients with macroadenomas demonstrate resistance to a dopamine agonist

  • Treatment might restore and maintain gonadal and neurologic function without normalization of prolactin levels or a change in tumor size

  • Tumors resistant to bromocriptine or quinagolide frequently respond to cabergoline

  • Trans-sphenoidal surgery should be reserved for treatment of patients who are intolerant of medical therapy, or in whom this has failed

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  1. fellow and J Schlechte is a professor in the Division of Endocrinology and Metabolism, Department of Internal Medicine at the University of Iowa, Iowa City, IA, USA

    Agusta Olafsdottir & Janet Schlechte

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Olafsdottir, A., Schlechte, J. Management of resistant prolactinomas. Nat Rev Endocrinol 2, 552–561 (2006). https://doi.org/10.1038/ncpendmet0290

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