Medical Therapies in Prolactinomas Patients Resistant to Bromocriptine

Abstract

Prolactinoma is the most common pituitary tumor. Bromocriptine(BRC) is a dopamine receptor agonist(DAs), which is one of the medical treatments for prolactinomas. However, about a quarter of patients are resistant to BRC. The aim of this article is to explore medical treatment for prolactinoma patients who are resistant to BRC, including increasing the dose of BRC and substituting drugs (cabagoline, temozolomide). Since prolactinomas is predominantly microadenoma, medical therapy based on DAs is the first-line treatment. Cabergoline (CAB), belong to DAs, is progressively substituted for BRC because of its excellent tolerability and better efficacy. In addition, small percentage of patients with prolactinomas are aggressive, this means that they are naturally resistant to DAs. High doses of CAB and standard doses of TMZ are treatments for aggressive prolactinoma, however, the use of high-dose CAB has been linked to an increased risk of cardiac valvopathy in patients with both Parkinson's disease and prolactinoma. Hence, TMZ, last conservative treatment, is recommended for this subset of patients.