Other therapy for a prolactinoma

The combined oral contraceptive pill can be used instead of dopamine agonist therapy for a woman with a microprolactinoma who does not desire fertility and who does not have distressing symptoms (eg galactorrhoea). The estrogen provides skeletal protection against the effects of secondary amenorrhoea.

Pituitary surgery for prolactinomas is generally reserved for patients who cannot tolerate or are resistant to dopamine agonists (ie require a high dose without complete biochemical control). It may also be useful in selected cases, such as noninvasive adenomas in women desiring fertility. The majority of surgical studies show low rates of postoperative biochemical remission.

Radiotherapy is reserved for prolactinomas that continue to expand despite surgical and drug therapy. Radiotherapy usually arrests growth of a prolactinoma, but rarely normalises prolactin concentration.