1.Diagnosis: The diagnosis of prolactin adenoma can be made by combining typical clinical manifestations with laboratory tests for hyperprolactinemia and imaging of the saddle area.
Hyperprolactinemia: For patients with suspected pituitary prolactin adenoma, the requirements for venous blood sampling for prolactin measurement are: eat a normal breakfast (type of carbohydrate, avoid protein and fatty foods), and take blood by venipuncture after a half-hour break at 10:30-11:00 am. If serum prolactin >100-200ng/dl and other specific causes of hyperprolactinemia are excluded, the diagnosis of prolactin adenoma is supported. If serum prolactin is <100ng/dl, the diagnosis must be made with caution in the context of the specific case. 2. Treatment of prolactin microadenoma: The primary purpose of clinical treatment of PRL microadenoma is to preserve gonadal function and reproductive function, and drug therapy can achieve this purpose significantly and effectively, i.e., drugs can effectively control PRL levels, and after long-term effective DA treatment, microadenomas often shrink and sometimes disappear. Since only 5-10% of microadenomas progress to macroadenomas, control of tumor size is not the primary goal of drug therapy, and women who do not want to have children can be treated without DA. Women who have stopped menstruation can receive estrogen therapy, but PRL levels should be evaluated periodically, including review of dynamic enhanced MRI to observe changes in tumor size. 3. Cabergoline (CAB), and others are pergolide and quinagolide. The drugs normalize PRL levels and reduce tumor size significantly in the majority of patients, and they are indicated for tumors of all sizes. Since pergolide and quinagolide are less commonly used, they are not recommended by this consensus. 4. Bromocriptine Dosing: The initial dose of BRC (2.5mg per tablet) treatment is 0.625-1.25mg per day, which is recommended to be taken orally at night before bedtime with snack. Increase 1.25mg at weekly intervals until reaching two or three tablets per day. The side effects of upper gastrointestinal discomfort and upright hypotension are reduced by a slow dosing schedule and by taking with a snack at bedtime. 7.5mg per day is the effective therapeutic dose and can be gradually increased to 15mg per day if tumor volume and PRL are not well controlled. Continued dosing does not further improve treatment outcomes, so high doses above 15mg are not recommended, but rather a change to CAB therapy is recommended. Since BRC has been proven to be safe and effective, and is relatively inexpensive and available in most medical departments in China, bromocriptine is the drug of choice recommended for the treatment of prolactin adenoma in China. 5.Prolactin macroadenoma and giant adenoma treatment To treat patients with prolactin macroadenoma or giant adenoma, in addition to controlling PRL levels and preserving pituitary function, tumor volume should be reduced to improve clinical symptoms. Except for acute tumor stroke-induced acute vision loss requiring emergency surgical decompression, DA remains the treatment of choice for the vast majority of patients with prolactinomatous or giant adenomas.