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Macroprolactinoma: Alternatives to Dopamine Agonist Therapy for Treatment of Macroprolactinomas in Patients Who Present with Psychotic Symptoms

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Pituitary Tumors

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Abstract

In patients with newly discovered macroprolactinomas, dopamine agonists are the treatment of choice to reduce prolactin levels and lactotroph hyperplasia. Cabergoline is an ergot derivative which demonstrates good efficacy for treatment of prolactinomas and is generally well tolerated by patients. Surgical intervention with a transsphenoidal resection performed by even the most experienced neurosurgeon is less likely to result in long-term biochemical remission and control of tumor growth when compared to medical therapy for prolactin-secreting tumors. An important consideration with use of dopamine agonists for prolactinomas is the development of psychotic symptoms. It is prudent to ascertain the patient’s past psychiatric history to determine whether dopamine agonists can be safely prescribed. If dopamine agonist therapy is initiated in the absence of any known prior psychosis, new signs and symptoms of psychosis should also be carefully monitored for the duration of therapy. In the case that discontinuation of dopamine agonist therapy is clinically warranted due to psychotic decompensation, secondary approaches for management include surgical intervention or radiation therapy for the prolactinoma and treatment of any underlying metabolic dysfunction due to hyperprolactinemia.

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Authors and Affiliations

  1. Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Suman Srinivasa

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  1. Suman Srinivasa
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Correspondence to Suman Srinivasa .

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  1. Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Lisa B. Nachtigall

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Srinivasa, S. (2018). Macroprolactinoma: Alternatives to Dopamine Agonist Therapy for Treatment of Macroprolactinomas in Patients Who Present with Psychotic Symptoms. In: Nachtigall, L. (eds) Pituitary Tumors. Springer, Cham. https://doi.org/10.1007/978-3-319-90909-7_2

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  • DOI: https://doi.org/10.1007/978-3-319-90909-7_2

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