Pituitary tumors are common tumors of the saddle area and can be classified as growth hormone adenoma, prolactin adenoma, thyroid stimulating hormone adenoma, adrenal stimulating hormone adenoma, gonadotropin adenoma, zero hormone adenoma and multi-hormone adenoma. Among them, prolactin adenomas often cause amenorrhea, lactation and infertility in women, decreased function in men, and increased tumor size can lead to vision loss and visual field loss. Currently, dopamine agonists are the preferred treatment for prolactin adenomas after diagnosis, rather than surgical removal.
Bromocriptine is the most commonly used drug in China for the treatment of prolactinopituitary tumors, which can normalize prolactin and reduce the size of the tumor in about 70-80% of patients. However, the treatment of prolactinopituitary tumors requires long-term use of this medication, and many patients experience a rebound after stopping it. However, not all prolactinopituitary tumors require lifelong medication to control prolactin and tumors, and some patients with prolactinopituitary tumors can maintain normal prolactin levels and tumor size even after discontinuing bromocriptine treatment. Current studies have shown that 40.8% of small pituitary microadenomas can be discontinued, while only 15.1% of large adenomas can be discontinued without rebound.
Since some people with lactinopituitary tumors do rebound after stopping bromocriptine, there is controversy about how long to treat with bromocriptine and at what point to stop. The current view is that if the prolactin pituitary tumor is treated with bromocriptine and the prolactin drops to normal, and if the tumor volume is reduced by more than half after 2-3 years of drug treatment, you can try to stop taking the drug. As for the age and gender of the pituitary tumor patient, there is no relationship with the timing of discontinuation. However, if you can control your prolactin at normal levels with a relatively small dose of the drug before stopping, and if the tumor has mostly shrunk in size and the patient has reached menopause, the chances of rebound of prolactin after stopping the drug are relatively small.
After discontinuation of bromocriptine for prolactinopituitary tumors, it is important to be vigilant for the re-increase of prolactin and the increase of tumor size. The median time to rebound elevation of prolactin after discontinuation of bromocriptine therapy for prolactinomas is about 3 months after discontinuation, with more than 90% occurring within 1 year, and a quarter of people experiencing a decline in sexual function after re-elevation of prolactin. Therefore, during the first 1 year of discontinuation, the lactogen should be rechecked every 3 months, and after 1 year, the lactogen should be rechecked annually.