Treatment for prolactinomas and hyperprolactinaemia: a lifetime approach

Abstract

Background: Prolactinomas are the most common hormone-secreting pituitary tumours and are amenable to medical therapy with dopamine agonists. Indication for treatment will most commonly result from hypogonadism, infertility or symptoms related to tumour size. Thus, both diagnosis and treatment will essentially depend on the patients' stage of life, namely prepubertal, reproductive or postreproductive stage. This review will focus on a lifespan-dependent diagnosis and treatment for prolactinoma and hyperprolactinaemia.

Methods: PubMed, the Cochrane Library, the Web of Science and EMBASE were searched electronically. No restriction was made with respect to language. Relevant current articles will be included in this review.

Results: Prevalence of prolactinomas and clinical symptoms are age group-specific, and treatment of first choice is dopamine agonists over the whole lifespan. Open questions in the treatment for hyperprolactinaemia include optimal choice and duration of pharmacological treatment. In addition, concerns have been raised on the safety of dopamine agonists since a reported association of valvular heart disease with dopaminergic treatment in patients with Parkinson's disease.

Conclusions: Clinical presentation and consequences of hyperprolactinaemia and prolactinoma will differ in the specific stages of reproductive life and require an adequate lifetime-dependent diagnostic and therapeutic approach.