Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19

Prolactinoma and Galactorrhea 1221

■Macroprolactinoma:

➣Dopaminergic agents (bromocriptine or cabergoline) as first-line

therapy to decrease serum prolactin (successful >90% of cases)

and shrink tumor (successful >70% of patients).

➣Transsphenoidal or transfrontal surgery to debulk tumor if

dopaminergic agents are unsuccessful or if patient desires preg-

nancy and tumor is near optic chiasm

■Microprolactinoma:

➣Dopaminergic agents as first-line therapy to restore fertility in

women

➣Transsphenoidal surgical removal of tumor if medications not

tolerated; recurrence rate >30%

➣If fertility is not desired and menses occur at least every 2–3 mo,

no therapy; repeat MRI in 3 mo, and then q 6–12 mo to determine

if tumor growing; microadenomas rarely grow

➣If fertility not desired and no menses, may use oral contraceptive

to provide estrogen and prevent osteoporosis

➣Idiopathic hyperprolactinemia:

Rule out use of medications that increase prolactin (eg, phe-

nothiazines)

Treat like microprolactinoma

Treatment Goals

■Decrease or normalize serum prolactin

■Shrink pituitary tumor

■Maintain normal pituitary function

■Fertility

➣Cessation of galactorrhea

➣Restoration of libido/potency

Side Effects & Contraindications

■Bromocriptine and cabergoline:

➣Side effects (more prominent with bromocriptine): gastric upset,

nasal stuffiness, orthostatic hypotension with initial doses;

always take medications with food

➣Contraindications: not recommended to stop postpartum galac-

torrhea or normoprolactinemic galactorrhea

follow-up

■Start bromocriptine with small doses and work up to full therapeutic

dose (2–3 times daily) over at least 1–2 wks

■Cabergoline given once or twice weekly