Prolactinomas, the most prevalent type of neuroendocrine disease, account for approximately 40% of all
pituitary adenomas. The most important clinical problems associated with
prolactinomas are
hypogonadism,
infertility and hyposexuality. In patients with
macroprolactinomas, mass effects, including visual field defects,
headaches and neurological disturbances, can also occur. The objectives of
therapy are normalization of
prolactin levels, to restore eugonadism, and reduction of
tumor mass, both of which can be achieved in the majority of patients by treatment with
dopamine agonists. Given their association with minimal morbidity, these drugs currently represent the mainstay of treatment for
prolactinomas. Novel data indicate that these agents can be successfully withdrawn in a subset of patients after normalization of
prolactin levels and
tumor disappearance, which suggests the possibility that medical
therapy may not be required throughout life. Nevertheless, multimodal
therapy that involves surgery,
radiotherapy or both may be necessary in some cases, such as patients who are resistant to the effects of
dopamine agonists or for those with atypical
prolactinomas. This Review reports on efficacy and safety of
pharmacotherapy in patients with
prolactinomas.