1. Indications.
All patients diagnosed with prolactin adenoma by neurosurgeons who think they can be treated with medication (surgery is preferred for patients with acute visual loss or impaired consciousness and is not suitable for medication).
(1) General prolactin >100ng/ml,
(2) Magnetic resonance of the saddle area confirms a pituitary tumor (must be seen by a neurosurgeon, not just based on the MRI report)
(3) Clinical symptoms: decreased sexual function in men, menopause and lactation in women.
It must be noted: blood test T3,T4,TSH, if T3,T4 are below normal value and TSH is abnormally high, the diagnosis is pituitary hyperplasia and cannot be treated as pituitary tumor!
2.General principles of drug taking.
In order to avoid or reduce the side effects of drugs, start with small doses, gradually increase the dose to normal lactogen and then maintain it with the minimum effective amount, and then gradually reduce the dose after the tumor volume is reduced.
3.Dosing method.
The first choice is bromocriptine (2.5mg per tablet) (the following dosing method is for reference only, adjust according to physician’s opinion) 1 time 1.25 or 2.5mg, 1 time per day; increase one tablet per week, increase to 3 tablets per day and review lactogen after one week; if it is not normal, continue to increase, generally increase to 6 tablets per day after control and maintain, review lactogen after one week of taking 6 tablets per day, if it is normal, continue to maintain and review lactogen after one week of taking 6 tablets per day. If it is normal, continue to maintain, and after 3 months of taking the medication, review the MRI and lactogen, and adjust the medication according to the test results.
Some patients who are still not under control with 6 tablets per day can continue to take 1 tablet per week and increase the dosage to 15 tablets per day. If it is still not controlled, consider changing the medication to carte blanche (the medication needs to be bought from Hong Kong or abroad), or consider surgery. Some patients may experience headache, dizziness, nausea and vomiting at the beginning of the medication, which can be started from 1/4 tablet per day, usually these reactions will disappear after a few days.
4.Pregnancy related problems
If you want to get pregnant, you should control your lactogen at 5-15ng/ml. It is not easy to get pregnant if it is too low or too high. Continue taking the drug after pregnancy until 16 weeks of pregnancy (i.e. four months) and stop taking it directly. Patients with pituitary macroadenoma may also continue on the original dose. Medications should not be adjusted during pregnancy based on prolactin levels because pregnancy itself results in a physiological increase in prolactin, so there is no need to review prolactin after pregnancy.
Effects of the drug on the fetus: No adverse effects have been found after extensive clinical experience at home and abroad.
5.Which patients can consider stopping the drug
(1) Prolactin is in the normal range.
(2) The tumor disappears on MRI dynamic enhancement examination of the saddle area
(3) The above conditions have been controlled for at least 2 years.
After discontinuation of the drug, it is still necessary to review lactogen and saddle area MRI regularly, because the tumor recurrence rate is higher after discontinuation of the drug.
6.Surgery compared with medication
The success rate of pregnancy is higher after taking medication to control lactogen, so medication is preferred.
7. Drug therapy is preferred for pituitary prolactin adenoma that invades the surrounding structures.
Because total excision is not possible with surgery, postoperative medication is required. Drug therapy alone can lead to the complete disappearance of many prolactin adenomas.