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The goal of treatment is to return prolactin secretion to normal, reduce tumor size, correct any visual abnormalities and restore normal pituitary function. In the case of very large tumors, only partial achievement of this goal may be possible. Because dopamine is the chemical that normally inhibits prolactin secretion, doctors first treat a prolactinoma with dopamine agents (agonists).
There are two dopamine agents that are often prescribed. Cabergoline may be offered as a weekly dose and my be more effective and better tolerated that Bromocriptine, which is taken daily.
Bromocriptine shrinks the tumor and returns prolactin levels to normal in the majority of patients. To avoid side effects such as nausea and dizziness, it is important for bromocriptine treatment to start slowly. Usual maintenance doses are 2.5 (one tablet) to 7.5 mg (3 tablets) daily.
Bromocriptine treatment should not be interrupted without consulting an endocrinologist. Prolactin levels often rise again in most people when the drug is discontinued.
While medical treatment is often the first option for prolactinomas, in selected cases, surgical treatment might be a better choice than long-term medication because surgery is curative in a high percentage of cases.