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in prolactionoma case,
what's the first treatment to try.
1)bromocriptine and cabergoline
2)transsphenoidal surgery

how can we dicide?

initial bromo

thanks sami.

i found a case in UW that chose surgery for non functioning adenoma.
that explains bromo is less effective than surgery.
any idea about it?

Initial Bromo.

Not responding then Surgery.

if you have a NON functioning adenoma, you can't call it prolactinoma then, it would be just like a mass in the brain with or without sign of increase ICP, and surg would be best option

Treatment

Not everyone needs treatment for prolactinoma.

Medication is usually successful in treating prolactinoma. Surgery is done in some cases where the tumor may damage vision.

In women, treatment can improve:

Infertility

Irregular menstruation

Loss of sexual interest

Milk flow not related to childbirth or nursing

Men should be treated when they have:

Decreased sexual drive

Impotence

Infertility

Large prolactinomas generally must be treated to prevent vision loss.

Bromocriptine and cabergoline are drugs that reduce prolactin levels in both men and women. They usually must be taken for life. If the drug is stopped, the tumor may grow and produce prolactin again, especially if it is a large tumor. Most people respond well to these drugs, although large prolactinomas are more difficult to treat. Both drugs may cause dizziness and upset stomach.

Using bromocriptine over time can reduce the chance of being cured by removing the tumor. Therefore, if surgery is needed, it is best to remove the tumor during the first 6 months of using this drug.

Radiotherapy with conventional radiation or gamma knife is usually reserved for patients with prolactinoma that continues or gets worse after both medication and surgery.

might be helpful