How Is Prolactinoma Treated?

Prolactinoma is a pituitary adenoma that develops from prolactin-producing cells in the pituitary gland, located at the base of the brain, and can lead to excessive secretion of the prolactin hormone. Most prolactinomas are benign. However, because they can disrupt hormonal balance and, especially in large tumors, put pressure on surrounding structures, regular evaluation of the patient is important.

The main goals of prolactinoma treatment are to bring blood prolactin levels closer to normal, reduce the size of the tumor, preserve or improve hormonal functions, and decrease the pressure exerted by the tumor on surrounding structures.

The treatment plan is not the same for every patient. The size of the tumor, prolactin level, the patient’s age, symptoms, visual functions, pregnancy plans, and the status of other pituitary hormones are evaluated together. In a detailed assessment by Prof. Dr. Ömür Günaldı, imaging results and the patient’s clinical findings can be considered together to plan the appropriate treatment approach.

What Is the Goal of Prolactinoma Treatment?

The aim of prolactinoma treatment is not only to shrink the tumor. It is also important to control the effects caused in the body by excessive prolactin secretion.

• To reduce the prolactin level in the blood
• To control tumor growth
• To shrink the tumor whenever possible
• To reduce pressure on the optic nerves
• To control symptoms such as menstrual irregularity and milk discharge
• To improve low testosterone levels and sexual function problems in men
• To help restore fertility
• To preserve the normal functions of the pituitary gland

Especially in large prolactinomas, the treatment plan should be individualized.

Can Prolactinoma Be Treated with Medication?

Yes. In a significant proportion of prolactinomas, medication is one of the first treatment options. Drugs called dopamine agonists are commonly used in treatment.

Dopamine is part of a natural mechanism that suppresses prolactin secretion from the pituitary gland. Dopamine agonists mimic this effect and help reduce prolactin production.

The main dopamine agonists used in prolactinoma treatment are:

• Cabergoline
• Bromocriptine

In current clinical practice, cabergoline is frequently preferred because of its effectiveness and generally better tolerability.

Prof. Dr. Ömür Günaldı evaluates whether medication treatment is appropriate together with the patient’s prolactin levels, tumor size, symptoms, and MRI findings.

Do Prolactinoma Medications Shrink the Tumor?

Dopamine agonists are not used only to reduce prolactin levels. In many patients, they may also help shrink the tumor.

Especially in large prolactinomas, tumor shrinkage may be important in reducing pressure on the optic nerves.

After treatment begins, patients are monitored at certain intervals. During follow-up, the following are generally evaluated:

• Prolactin level
• Other pituitary hormones
• Tumor size
• Visual functions
• The patient’s symptoms
• Possible medication-related side effects

Changes in tumor size are monitored with pituitary MRI when necessary.

How Long Does Prolactinoma Medication Treatment Last?

The duration of treatment may vary from person to person. Some patients may require long-term medication use, while in some patients with appropriate characteristics, reducing or discontinuing the medication under medical supervision may be considered after a certain period of treatment.

When deciding whether the medication can be discontinued, factors such as prolactin levels remaining normal for a long time, the dose of medication used, and significant tumor shrinkage on MRI may be taken into consideration.

For this reason, prolactinoma medications should not be stopped by the patient on their own. Prof. Dr. Ömür Günaldı can evaluate the response to treatment through regular check-ups and decide whether medication treatment should continue or whether changes are necessary.

When Is Prolactinoma Surgery Necessary?

Medication treatment can be highly effective in most prolactinomas. However, surgical treatment may be considered in some patients.

Surgery may especially be considered in the following situations:

• Inadequate response to medication treatment
• Inability to use the medication because of serious side effects
• Continued tumor growth
• Severe pressure on the optic nerves or other important surrounding structures
• Surgery being an appropriate alternative based on the patient’s characteristics
• Preference for surgical treatment in selected small or limited prolactinomas

In deciding on surgery, not only the size of the tumor but also its location within the pituitary gland and its proximity to surrounding vascular and neural structures are important.

Therefore, the patient’s pituitary MRI images can be evaluated in detail by Prof. Dr. Ömür Günaldı to determine whether surgical treatment is necessary.

How Is Prolactinoma Surgery Performed?

In prolactinoma surgery, transsphenoidal surgery is generally used in suitable patients. With this approach, the pituitary region is usually reached through the nose.

One of the important advantages of this method is that the pituitary region can be accessed without creating a large surgical opening in the skull.

The main goals of surgery can be listed as:

• Removing tumor tissue as safely as possible
• Controlling prolactin secretion
• Reducing pressure on the optic nerves
• Preserving healthy pituitary tissue as much as possible

Surgical success may vary depending on the size and location of the tumor, its spread to surrounding tissues, and the experience of the surgical team.

How Is Follow-Up Performed After Prolactinoma Surgery?

Patients need to be followed regularly after surgical treatment. After surgery, the following may be evaluated:

• Prolactin level
• Cortisol
• Thyroid hormones
• Other pituitary hormones
• Fluid and electrolyte balance
• Visual functions
• MRI images

Because the pituitary gland plays a role in controlling many hormone systems in the body, hormonal evaluation is particularly important after surgery.

Prof. Dr. Ömür Günaldı can plan the necessary follow-up by evaluating the patient’s hormonal and neurological status together during the postoperative period.

Is Radiotherapy Used in Prolactinoma?

Radiotherapy is generally not the first treatment option in prolactinoma. It may be considered in selected cases where medication and surgical treatments are insufficient, the tumor cannot be completely removed, or the tumor shows progressive features.

Today, stereotactic radiotherapy or radiosurgery methods may be used in appropriate patients.

However, the effect of radiotherapy may not appear immediately, and patients need regular follow-up because of its long-term effects on pituitary hormones.

For this reason, the decision to use radiotherapy may be made through a multidisciplinary evaluation involving fields such as endocrinology, neurosurgery, and radiation oncology.

How Is Microprolactinoma Treated?

Prolactinomas smaller than 10 mm in diameter are generally called microprolactinomas.

The treatment decision in microprolactinomas may vary according to the patient’s symptoms. In some small tumors that do not cause symptoms, regular follow-up may be sufficient, while medication treatment may be preferred in patients with hormonal disorders or clinical complaints.

In particular, symptoms such as:

• Menstrual irregularity
• Difficulty becoming pregnant
• Milk discharge
• Decreased sexual desire
• Low testosterone

are important in evaluating the need for treatment.

Prof. Dr. Ömür Günaldı may create an individualized approach by taking into account that small prolactinomas are not always treated in the same way and that the patient’s hormone results, symptoms, and imaging findings should be evaluated together.

How Is Macroprolactinoma Treated?

Prolactinomas that are 10 mm or larger in diameter are classified as macroprolactinomas.

In large tumors, not only hormonal symptoms but also the pressure exerted by the tumor on surrounding tissues becomes important.

When macroprolactinomas grow upward toward the optic chiasm, where the optic nerves are located, visual field problems may develop.

One of the main treatment goals in these patients is to reduce tumor size as quickly and safely as possible. Dopamine agonists are the first treatment approach in most patients. Surgical treatment may be considered when an adequate response to treatment cannot be achieved.

Can Prolactinoma Cause Vision Problems?

Small prolactinomas generally do not cause vision problems. However, large tumors may grow upward and press on the optic nerves.

Problems such as:

• Narrowing of the visual field
• Difficulty seeing to the sides
• Decreased visual acuity
• Double vision in some patients

may develop.

Patients with vision loss or visual field changes should be evaluated without delay.

Prof. Dr. Ömür Günaldı can assess the relationship between the tumor and the visual pathways in large prolactinomas by evaluating MRI images together with visual field tests when necessary.

Prolactinoma and Pregnancy

High prolactin levels can suppress ovulation and make it difficult for women to become pregnant. After effective treatment, ovulation and fertility may be restored as prolactin levels decrease.

For this reason, it is important to plan treatment before pregnancy in patients with prolactinoma who are planning to have children.

When pregnancy occurs, whether medications should be continued is determined by the doctor according to tumor size and individual risks. Especially in large prolactinomas, closer follow-up may be required during pregnancy.

Can Prolactinoma Be Completely Cured?

Prolactinoma is a pituitary tumor that can be effectively controlled in most patients. With medication treatment, prolactin levels may return to normal and the tumor may shrink significantly.

In some patients, prolactin levels may remain normal even after medication is discontinued following long-term treatment. In suitable patients who undergo surgery, long-term remission may be achieved.

However, the outcome is not the same in every patient. Tumor size, extent, initial prolactin level, and response to treatment can affect long-term outcomes.

The Importance of Regular Follow-Up in Prolactinoma Treatment

Success in prolactinoma treatment is not limited only to taking medication or undergoing surgery. Long-term follow-up is an important part of treatment.

During follow-up visits, prolactin levels, other pituitary hormones, and MRI results when necessary are evaluated. In large tumors, visual field examinations may also be added to the follow-up program.

Prof. Dr. Ömür Günaldı may plan the treatment process by taking into account the importance of monitoring not only tumor size but also hormonal functions and clinical symptoms together in prolactinoma treatment.

The answer to the question “How is prolactinoma treated?” varies according to the size of the tumor, prolactin level, the patient’s symptoms, and the response to treatment. Dopamine agonist medications are effective in a significant proportion of prolactinomas and can both reduce prolactin levels and shrink the tumor.

In selected patients where medication treatment is insufficient, cannot be tolerated, or the tumor places pressure on important surrounding structures, surgical treatment may be considered. Radiotherapy is generally evaluated in special situations where other methods are insufficient.

In a detailed evaluation by Prof. Dr. Ömür Günaldı, the size of the tumor, pituitary hormones, MRI images, visual functions, and the patient’s overall clinical condition can be assessed together to create an individualized treatment and follow-up program.