How to treat pituitary prolactinoma? This depends on the size of the tumor and whether high prolactin causes symptoms. Generally speaking, drug therapy is the first choice. If the drug effect is poor or there is drug resistance, transsphenoidal surgery can be considered for treatment, while radiotherapy is only used as an adjuvant therapy. The treatment methods for pituitary prolactinoma are as follows:
1. Drug therapy (preferred)
After more than 20 years of clinical observation, it has been found that bromocriptine has achieved significant therapeutic effects in reducing serum prolactin levels, shrinking tumors, improving visual field defects and symptoms of cerebral nerve compression, and restoring gonadal function. At present, there are various new dopamine D2 receptor agonists available, such as pembrolizumab, quingolide, and camacoline.
2. Surgical treatment (transsphenoidal surgery)
The main surgical treatment is transsphenoidal surgery, which involves selective removal of adenoma tissue through the oral or nasal sphenoid pathway, while preserving normal pituitary tissue. But some patients may not be able to completely remove it, and postoperative complications may include cerebrospinal fluid leakage, diabetes insipidus, intracranial infection, visual system damage, and pituitary dysfunction. Surgery can reduce the demand for drug therapy and improve patients' resistance to drugs after surgery.
3. Radiation therapy (adjuvant)
Radiation therapy is only an auxiliary method that can prevent tumor enlargement; But its slow reduction of PRL levels and unsatisfactory recovery of ovulatory menstruation are commonly used for patients who have not recovered after surgery. The complications of pituitary radiotherapy include hypothalamic dysfunction, pituitary dysfunction, visual system damage, cerebrovascular accidents, brain necrosis, secondary malignant or benign brain tumors, etc.
Regardless of the above treatment plan, regular monitoring of prolactin levels is necessary during the treatment process.
