, Volume 21, Issue 4, pp 425–430 | Cite as

Management of cystic prolactinomas: a review

  • Afif NakhlehEmail author
  • Naim Shehadeh
  • Irit Hochberg
  • Moshe Zloczower
  • Sagit Zolotov
  • Riad Taher
  • Deeb Daoud Naccache



Cystic prolactinoma is a variant of prolactin-secreting pituitary adenoma. The strategies for the management of cystic prolactinoma have not been addressed thoroughly in clinical guidelines.


A literature search was performed using Pubmed to review the current approaches to the treatment of cystic prolactinoma.


Transsphenoidal resection is an effective and relatively safe approach for the treatment of cystic prolactinoma, however, morbidity of surgery is dependent on the skill of the surgeon. Emerging studies allude to the efficacy and safety of dopamine agonists in the management of cystic prolactinoma. Dopamine agonists are associated with considerable rates of clinical improvement and tumor shrinkage, hence reducing the need for surgical intervention.


Recent studies suggest that dopamine agonist therapy may be an effective and safe treatment option in a considerable portion of patients with cystic prolactinomas. We suggest that dopamine agonists should be considered as a first-line therapy for cystic prolactinoma in the absence of indications for early surgical intervention.


Cystic prolactinoma Dopamine agonist Transsphenoidal surgery Apoplexy 


Compliance with ethical standards

Conflict of interest

The authors declare that there are no conflicts of interest.


  1. 1.
    Iglesias P, Díez JJ (2013) Macroprolactinoma: a diagnostic and therapeutic update. QJM 106:495–504CrossRefPubMedGoogle Scholar
  2. 2.
    Karavitaki N, Thanabalasingham G, Shore HC et al (2006) Do the limits of serum prolactin in disconnection hyperprolactinaemia need re-definition? A study of 226 patients with histologically verified nonfunctioning pituitary macroadenoma. Clin Endocrinol 65:524–529CrossRefGoogle Scholar
  3. 3.
    Faje A, Chunharojrith P, Nency J et al (2016) Dopamine agonists can reduce cystic prolactinomas. J Clin Endocrinol Metab 101:3709–3715CrossRefPubMedGoogle Scholar
  4. 4.
    Casanueva FF, Molitch ME, Schlechte JA et al (2006) Guidelines of the pituitary society for the diagnosis and management of prolactinomas. Clin Endocrinol 65:265–273CrossRefGoogle Scholar
  5. 5.
    Melmed S, Casanueva FF, Hoffman AR et al (2011) Diagnosis and treatment of hyperprolactinemia: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96:273–288CrossRefPubMedGoogle Scholar
  6. 6.
    Ogiwara T, Horiuchi T, Nagm et al (2017) Significance of surgical management for cystic prolactinoma. Pituitary 20(2):225–230CrossRefPubMedGoogle Scholar
  7. 7.
    Kreutzer J, Buslei R, Wallaschofski H, Hofmann B, Nimsky C, Fahlbusch R, Buchfelder M (2008) Operative treatment of prolactinomas: indications and results in a current consecutive series of 212 patients. Eur J Endocrinol 158:11–18CrossRefPubMedGoogle Scholar
  8. 8.
    Bahuleyan B, Menon G, Nair S, Rao BR, Easwer HV, Krishna K (2009) Non-surgical management of cystic prolactinomas. J Clin Neurosci 16:1421–1424CrossRefPubMedGoogle Scholar
  9. 9.
    Bukowczan J, Lois K, Mathiopoulou M, Grossman AB, James RA (2016) Reversal of severe cognitive impairment following medical treatment of cystic invasive giant prolactinoma. Endocrinol Diabet Metab Case Rep 2016:150111. CrossRefGoogle Scholar
  10. 10.
    Delgrange E, Gustin T (2005) Cystic macroprolactinoma: primary medical treatment? Intern Med J 35:687–688CrossRefPubMedGoogle Scholar
  11. 11.
    Prague JK, Ward CL, Mustafa OG, Whitelaw BC, King A, Thomas NW, Gilbert J (2014) Delayed presentation of late-onset cerebrospinal fluid rhinorrhea following dopamine agonist therapy for giant prolactinoma. Endocrinol Diabet Metab Case Rep 2014:140020. CrossRefGoogle Scholar
  12. 12.
    Lima GAB, Machado Ede O, Dos Santos Silva CM, Filho PN, Gadelha MR (2008) Pituitary apoplexy during treatment of cystic macroprolactinomas with cabergoline. Pituitary 11:287–292CrossRefGoogle Scholar
  13. 13.
    Briet C, Salenave S, Bonneville JF, Laws ER, Chanson P (2015) Pituitary apoplexy. Endocr Rev 36(6):622–645CrossRefPubMedGoogle Scholar
  14. 14.
    Nishioka H, Haraoka J, Akada K, Azuma S (2002) Gender-related differences in prolactin secretion in pituitary prolactinomas. Neuroradiology 44(5):407–410CrossRefPubMedGoogle Scholar
  15. 15.
    Inder WJ, Macfarlane MR (2004) Hyperprolactinaemia associated with a complex cystic pituitary mass: medical versus surgical therapy. Intern Med J 34:573–576CrossRefPubMedGoogle Scholar
  16. 16.
    Park M, Lee SK, Choi J et al (2015) Differentiation between cystic pituitary adenomas and Rathke cleft cysts: a diagnostic model using MRI. AJNR Am J Neuroradiol 36:1866–1873CrossRefPubMedGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Institute of Endocrinology, Diabetes and MetabolismRambam Health Care CampusHaifaIsrael

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