Lactotroph adenoma treatment
Treatment is indicated to correct hypogonadism, restore other hormonal deficits, and alleviate local mass effects 1)
Controversies
Are dopamine agonists still the first-choice treatment for prolactinoma in the era of endoscopy?
Can et al. suggested that neurosurgeons and endocrinologists has to conduct high-quality clinical trials to address the clinical equipoise quantitatively 2).
Surgical intervention may resurface as an alternative first-line treatment. When used in combination with cabergoline, surgery offers a higher disease remission rate than either drug or operation alone 3)
Lactotroph Adenoma Surgery is safe and efficient. It is particularly suitable for enclosed prolactinomas. The patient should be well informed of the pros and cons of the treatment options, which include dopamine agonist (DA) and transsphenoidal microsurgery, and the patient's preference should be taken into account during decision-making 4).
In the absence of visual deficits, pituitary apoplexy in lactotroph adenomas is the only type of pituitary tumor for which medical therapy (Dopamine agonists) may be the primary treatment.
Issues and questions to be addressed in this approach to long-term management of prolactinomas include the frequency of radiographic monitoring, effect of pregnancy and menopause, safety of estrogen in women taking oral contraceptives, and the potential for discontinuation of dopamine agonist therapy 5).
Lactotroph adenoma Medical Therapy
Surgery
Radiosurgery
Serial imaging
The underlying decision to perform serial imaging in prolactinoma patients should be individualized on a case-by-case basis. Future studies should focus on alternative imaging methods and/or contrast agents 6).