Current approach to treatments for prolactinomas.

Prolactinomas are pituitary tumors that originate from the adenohypophysis lactotroph cells. These tumors constitute one third of all pituitary adenomas, making them the most common functional pituitary neoplasms. The signs and symptoms of patients harboring prolactin (PRL) secreting tumors may derive from hyperprolactinemia itself, as well as from direct pressure of the expanding mass on the normal pituitary gland and other surrounding tissues, in cases of invasive tumors. This review will focus on practical aspects of the medical treatment of patients with prolactinomas, and on the main differences between the treatment strategy of micro- and macroprolactinomas. Medical therapy with dopamine agonists (DA) is the preferred treatment for the vast majority of patients harboring prolactinomas. Cabergoline (CAB) is the main agent used for treating prolactinomas, achieving normoprolactinemia in 80-100% of patients with microprolactinomas, and in 75-95% of those with macroprolactinomas. Second line therapies include surgery and radiation therapy, and are indicated only in rare cases, such as patients intolerant to, or with contraindication for DAs, or patients harboring malignant or DA resistant tumors. The management principles of pregnant women with prolactinomas and of patients with suspected malignant prolactinoma are distinct from other patient populations, and are discussed separately in our review.