HYPERPROLACTINEMIA: GALACTORRHEA-AMENORRHEA SYNDROME - Treatment



For tumors located in the sella, or with minimal suprasellar extension, the treatment of choice is microsurgery via the transsphenoidal approach. This procedure preserves the surrounding normal -;• pituitary tissue and rarely results in hypopitui­tarism. Pituitary irradiation, using either conven­tional sources or heavy particle beams, is also frequently successful, but the incidence of ” hypopituitarism is greater than in patients treated with transsphenoidal hypophysectomy. This may be a very important consideration in women in the child-bearing years or in children who have not yet achieved adult height. Bromocriptine, a dopamine agonist, can be used as a medical al­ternative to surgical management of patients with hyperprolactinemia. Doses of 10 to 15 mg daily will usually result in cessation of lactation, re­sumption of menses and fertility, and restoration of libido and potency. Bromocriptine may also re­sult in regression of the tumor per se, although surgical therapy is probably indicated in patients with tumors large enough to produce neurologic symptoms. At the present time bromocriptine should probably be reserved for patients with small tumors and those in whom surgery is con-traindicated, or as adjunctive treatment of tumors that cannot be completely resected.