The Management of Prolactin-Secreting Pituitary Adenomas

Abstract

Advances in the investigation and treatment of pituitary tumours over the past decade have necessitated a major reappraisal of the management of these lesions. The recognition that prolactin-secreting pituitary adenomas (prolactinomas) not only represent a further sub-group of secretory tumours but may in fact be the commonest type of pituitary tumour has come at an appropriate time. Refinements in neuroradiological techniques and transphenoidal surgery and the introduction of the dopamine-agonist bromocriptine now offer prospects for early detection and effective treatment, either by selective adenomectomy or by non-invasive therapy with bromocriptine. In a study of 67 patients with large prolactin-secreting pituitary adenomas, 33 have undergone computerised tomography and metrizamide cisternography for assessment of tumour size. In ten of these patients repeat scans following bromocriptine therapy have shown reduction in prolactinoma size in eight. The two patients with no change in tumour size differed from the rest, having received a lower dose of bromocriptine and had prolactinomas as part of the multiple endocrine adenomatosis syndrome (Type I).