Prolactinoma medical therapy: Difference between revisions

	Prolactinoma Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Prolactinoma from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
ECG
X-ray
Ultrasound
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Prolactinoma medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Prolactinoma medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Prolactinoma medical therapy
CDC on Prolactinoma medical therapy
Prolactinoma medical therapy in the news
Blogs on Prolactinoma medical therapy
Directions to Hospitals Treating Prolactinoma
Risk calculators and risk factors for Prolactinoma medical therapy

VisualWikitext

Latest revision as of 23:49, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2], Faizan Sheraz, M.D. [3]

Overview

Medical therapy for prolactinoma includes dopamine agonists (either cabergoline or bromocriptine). The goals of treatment include lowering the prolactin secretion to normal, reduction of tumor size, correction of any visual abnormalities, and restoration of normal pituitary function.

Medical Therapy

Medical therapy for prolactinoma includes dopamine agonists (cabergoline or bromocriptine).^[1]^[2]^[3]^[4]^[5]
- Preferred regimen: Cabergoline 0.25 mg PO twice weekly or 0.5 mg PO once per week
  - The dose may be gradually increased every 4 weeks as needed
  - The maximum dose can be administered up to 1 mg PO twice per week
- Alternative regimen: Bromocriptine 1.25 mg PO once daily at bedtime for 1 week
  - The dose may be gradually increased every 3 to 7 days as needed and taken in divided doses

These drugs reduce the tumor size in approximately 85% of cases and lower the prolactin concentration to normal in more than 90% of patients.
Both drugs have been approved by the U.S Food and Drug Administration for the treatment of hyperprolactinemia.

Medical therapy in pregnancy

Bromocriptine is considered safe to use during pregnancy.^[1]

Indications for withdrawal of dopamine agonist therapy

Dopamine therapy can be tapered down to lower doses if the patient fulfills the following criteria:^[1]
- Normal prolactin level for at least 2 years.
- Reduction in tumor size by at least 50%.
- No compression of optic chiasm.
Drug cessation can be tried if:
- Cavernous sinus invasion is not present.

Radiation Therapy

Rarely, radiation therapy is used if medical therapy and surgery fail to reduce prolactin concentration. Depending on the size and location of the tumor, radiation is delivered either in low doses over the course of 5 to 6 weeks or in a single high dose. Radiation therapy is effective in approximately 30% of cases.^[2]

References

↑ ^1.0 ^1.1 ^1.2 Liu JK, Couldwell WT (2004). "Contemporary management of prolactinomas". Neurosurg Focus. 16 (4): E2. PMID 15191331.
↑ ^2.0 ^2.1 Colao A, Savastano S (2011). "Medical treatment of prolactinomas". Nat Rev Endocrinol. 7 (5): 267–78. doi:10.1038/nrendo.2011.37. PMID 21423245.
↑ Nomikos P, Buchfelder M, Fahlbusch R (2001). "Current management of prolactinomas". J Neurooncol. 54 (2): 139–50. PMID 11761431.
↑ "Prolactinoma | NIDDK".
↑ Ciccarelli E, Camanni F (1996). "Diagnosis and drug therapy of prolactinoma". Drugs. 51 (6): 954–65. PMID 8736617.

Template:WikiDoc Sources

[pmid15191331-1] 1.0 ^1.1 ^1.2 Liu JK, Couldwell WT (2004). "Contemporary management of prolactinomas". Neurosurg Focus. 16 (4): E2. PMID 15191331.

[pmid21423245-2] 2.0 ^2.1 Colao A, Savastano S (2011). "Medical treatment of prolactinomas". Nat Rev Endocrinol. 7 (5): 267–78. doi:10.1038/nrendo.2011.37. PMID 21423245.

[pmid11761431-3] Nomikos P, Buchfelder M, Fahlbusch R (2001). "Current management of prolactinomas". J Neurooncol. 54 (2): 139–50. PMID 11761431.

[urlProlactinoma_|_NIDDK-4] "Prolactinoma | NIDDK".

[pmid8736617-5] Ciccarelli E, Camanni F (1996). "Diagnosis and drug therapy of prolactinoma". Drugs. 51 (6): 954–65. PMID 8736617.

[1]

[2]

[3]

[4]

[5]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Prolactinoma}}
-{{CMG}} {{AE}}{{Faizan}}
+{{CMG}}; {{AE}}{{Anmol}}, {{Faizan}}
 ==Overview==
+Medical therapy for prolactinoma includes [[dopamine agonists]] (either [[cabergoline]] or [[bromocriptine]]). The goals of treatment include lowering the [[prolactin]] secretion to normal, reduction of [[tumor]] size, correction of any [[visual]] abnormalities, and restoration of normal [[pituitary]] function.
-Medical therapy for prolactinoma includes [[dopamine agonists]]. The goal of treatment is to:
-*Return [[prolactin]] secretion to normal
-*Reduce [[tumor]] size
-*Correct any visual abnormalities
-*Restore normal [[pituitary]] function
 ==Medical Therapy==
-Medical therapy for prolactinoma includes dopamine agonists ([[bromocriptine]] or [[cabergoline]]).
+*Medical therapy for prolactinoma includes [[Dopamine agonist|dopamine agonists]] ([[cabergoline]] or [[bromocriptine]]).<ref name="pmid15191331">{{cite journal| author=Liu JK, Couldwell WT| title=Contemporary management of prolactinomas. | journal=Neurosurg Focus | year= 2004 | volume= 16 | issue= 4 | pages= E2 | pmid=15191331 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15191331  }} </ref><ref name="pmid21423245">{{cite journal| author=Colao A, Savastano S| title=Medical treatment of prolactinomas. | journal=Nat Rev Endocrinol | year= 2011 | volume= 7 | issue= 5 | pages= 267-78 | pmid=21423245 | doi=10.1038/nrendo.2011.37 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21423245  }} </ref><ref name="pmid11761431">{{cite journal| author=Nomikos P, Buchfelder M, Fahlbusch R| title=Current management of prolactinomas. | journal=J Neurooncol | year= 2001 | volume= 54 | issue= 2 | pages= 139-50 | pmid=11761431 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11761431  }} </ref><ref name="urlProlactinoma | NIDDK">{{cite web |url=https://www.niddk.nih.gov/health-information/endocrine-diseases/prolactinoma |title=Prolactinoma &#124; NIDDK |format= |work= |accessdate=}}</ref><ref name="pmid8736617">{{cite journal |vauthors=Ciccarelli E, Camanni F |title=Diagnosis and drug therapy of prolactinoma |journal=Drugs |volume=51 |issue=6 |pages=954–65 |year=1996 |pmid=8736617 |doi= |url=}}</ref>
+**Preferred regimen: [[Cabergoline]] 0.25 mg PO twice weekly or 0.5 mg PO once per week
+***The dose may be gradually increased every 4 weeks as needed
+***The maximum dose can be administered up to 1 mg PO twice per week
+**Alternative regimen: [[Bromocriptine]] 1.25 mg PO once daily at bedtime for 1 week
+***The dose may be gradually increased every 3 to 7 days as needed and taken in divided doses
-'''Bromocriptine''': 25 mg PO OD for 1 week
+*These [[drug]]s reduce the [[tumor]] size in approximately 85% of cases and lower the [[prolactin]] concentration to normal in more than 90% of patients.
-The dose is gradually increased every 3 to 7 days as needed.
+*Both drugs have been approved by the U.S [[Food and Drug Administration]] for the treatment of [[hyperprolactinemia]].
-'''Cabergoline''': .25 mg PO twice a week
+===Medical therapy in pregnancy===
-The dose may be increased every 4 weeks as needed, up to 1 mg two times a week.
+*[[Bromocriptine]] is considered safe to use during [[pregnancy]].<ref name="pmid15191331">{{cite journal| author=Liu JK, Couldwell WT| title=Contemporary management of prolactinomas. | journal=Neurosurg Focus | year= 2004 | volume= 16 | issue= 4 | pages= E2 | pmid=15191331 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15191331  }} </ref>
-These drugs shrink the tumor and return prolactin levels to normal in approximately 80 percent of patients.  Both drugs have been approved by the U.S. Food and Drug Administration for the treatment of hyperprolactinemia.
+===Indications for withdrawal of dopamine agonist therapy===
+*[[Dopamine]] therapy can be tapered down to lower doses if the patient fulfills the following criteria:<ref name="pmid15191331">{{cite journal| author=Liu JK, Couldwell WT| title=Contemporary management of prolactinomas. | journal=Neurosurg Focus | year= 2004 | volume= 16 | issue= 4 | pages= E2 | pmid=15191331 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15191331  }} </ref>
+**Normal [[prolactin]] level for at least 2 years.
+**Reduction in [[tumor]] size by at least 50%.
+**No compression of [[optic chiasm]].
+*Drug cessation can be tried if:
+**[[Cavernous sinus]] invasion is not present.
 ==Radiation Therapy==
+*Rarely, [[radiation therapy]] is used if medical therapy and [[surgery]] fail to reduce [[prolactin]] concentration. Depending on the size and location of the [[tumor]], [[radiation]] is delivered either in low doses over the course of 5 to 6 weeks or in a single high dose. [[Radiation therapy]] is effective in approximately 30% of cases.<ref name="pmid21423245">{{cite journal| author=Colao A, Savastano S| title=Medical treatment of prolactinomas. | journal=Nat Rev Endocrinol | year= 2011 | volume= 7 | issue= 5 | pages= 267-78 | pmid=21423245 | doi=10.1038/nrendo.2011.37 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21423245  }} </ref>
-Rarely, radiation therapy is used if medical therapy and surgery fail to reduce prolactin levels.  Depending on the size and location of the tumor, radiation is delivered in low doses over the course of 5 to 6 weeks or in a single high dose. [[Radiation]] therapy is effective about 30 percent of the time.
 == References ==
@@ Line 30: / Line 35: @@
 {{WikiDoc Help Menu}}
 {{WikiDoc Sources}}
 [[Category:Disease]]
 [[Category:Neuroendocrinology]]
-[[Category:Mature chapter]]
+[[Category:Oncology]]
+[[Category:Medicine]]
+[[Category:Endocrinology]]
+[[Category:Up-To-Date]]
+[[Category:Neurology]]
+[[Category:Neurosurgery]]