Prolactinomas and tumor regression with dopamine agonist drugs.

From Lewis S Blevins Jr. MD –  Macroadenomas and massive macroadenomas tend to regress significantly in response to treatment with dopamine agonist drugs. I would say that about 30% of tumors do not regress at all and require debulking. Some of these tumors regress dramatically and it is impossible to see any evidence for residual disease while others may regress only 30-50%. There are no predictors of the degree of regression. Sometimes, the prolactin will normalize but the tumor does not regress at all. In other cases, the prolactin does not normalize but the tumor becomes “invisible.” When I was a younger physician I used to MRI regularly to follow the regression but now feel that this is unnecessary. My current practice is to wait until a nadir prolactin has been reached and wait 2-3 months thereafter to repeat an MRI. This approach decreases anxiety, builds confidence, and saves money. An MRI Performed 6-12 months after starting treatment seems reasonable If the prolactin does not normalize.

Microadenomas seem to be less likely to regress in response to treatment. No one knows why. I have seen tumors regress completely but most of them remain ever present, Perhaps a little decreased in size, despite normalization of serum prolactin concentrations.

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