Prolactinoma: How medication can help
Prolactinomas usually respond very well to medication – so-called dopamine agonists. These active substances bind to special docking sites on the surface of the prolactin-producing cells. This inhibits the release of prolactin and also ensures that the tissue overgrowth becomes smaller over time. The commonly used active ingredients are
- Cabergoline
- Quinagolide
- Bromocriptine
You will normally have to take the medication for several years. During this time, we regularly check the prolactin level in the blood and the function of the rest of the pituitary gland. The dosage of the medication is determined individually and adjusted over the course of the treatment. Only patients who take a higher dosage of the medication over a longer period of time also require ultrasound checks of the heart valves. With the help of magnetic resonance imaging, we can also check whether the prolactinoma shrinks when a dopamine agonist is taken. In over 90 percent of those treated, these drugs respond so well that the prolactin level normalizes.
Interdisciplinary collaboration
At the USZ we offer a wealth of experience in the treatment of patients with diseases of the pituitary gland. The particularly difficult or complicated cases benefit from the interdisciplinary cooperation of colleagues from endocrinology, neurosurgery, neuroradiology and radiotherapy in determining the optimal individualized treatment.
When is an operation necessary?
Occasionally, taking medication can lead to permanent side effects such as nausea, headaches, dizziness, tiredness, abdominal pain or psychological changes. If you cannot tolerate the medication, it may be advisable to change the medication or even have the prolactinoma surgically removed. This also applies if the medication does not have the desired therapeutic effect. In other words:
- the complaints persist,
- the prolactin levels are still too high,
- the size of the prolactinoma remains the same or even increases.
In most cases, the procedure is performed minimally invasively via the nose.
Radiotherapy only in exceptional cases
The full effect of radiation treatment often only becomes apparent five to ten years later. In addition, the function of the remaining pituitary gland is often impaired. Radiotherapy is therefore only used if neither treatment with medication nor surgery can alleviate the symptoms sufficiently.
