Abstract
Prolactinomas account for approximately 50% of all pituitary adenomas coming to medical attention and are an important cause of hypogonadism and infertility. The ultimate goal of therapy for prolactinomas is to restore or preserve eugonadism, through the normalization of hyperprolactinemia and reduction of tumor mass. Medical therapy with dopamine agonists, particularly with cabergoline, is highly effective in the majority of cases and represents the mainstay of therapy, even though recent concerns have been raised on potential neuropsychiatric effects of these drugs, as well as the possible but exceptional occurrence of cardiac valve alterations during long-term treatment at high cumulative doses. Challenging situations, such as those encountered with resistance to dopamine agonists, giant, atypical or malignant prolactinomas, may require multimodal therapy involving surgery, radiotherapy and/or specific chemotherapy. Progress in elucidating mechanisms underlying the pathogenesis of prolactinomas may enable future development of novel subcellular therapies for treatment-resistant patients.
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