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Division of Endocrinology, Metabolism and Molecular Medicine; Northwestern University Feinberg School of Medicine, Chicago, USA; Department of Molecular and Clinical Endocrinology and Oncology, University, "Federico II" of Naples, Italy
* To whom correspondence should be addressed. E-mail: colao{at}unina.it.
Prolactinomas account for approximately 40% of all pituitary adenomas and are an important cause of hypogonadism and infertility. The ultimate goal of therapy for prolactinomas is restoration or achievement of eugonadism, through the normalization of hyperprolactinemia, and control of tumor mass. Medical therapy with dopamine agonists are highly effective in the majority of cases and represent the mainstay of therapy. Recent data indicating successful withdrawal of these agents in a subset of patients challenge the previously held concept that medical therapy is a life-long requirement. Complicated situations, such as those encountered in resistance to dopamine agonists, pregnancy, and giant or malignant prolactinomas, may require multimodal therapy involving surgery, radiotherapy or both. Progress in elucidating the mechanisms underlying the pathogenesis of prolactinomas may enable future development of novel molecular therapies for treatment-resistant cases. This review provides a critical analysis of the efficacy and safety of the various modes of therapy available for the treatment of patients with prolactinomas with an emphasis on challenging situations, a discussion of the data regarding withdrawal of medical therapy, and a foreshadowing of novel approaches to therapy that may become available in the future.
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