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Pituitary Microadenomas Medication

  • Author: Bernard Corenblum, MD, FRCPC; Chief Editor: George T Griffing, MD  more...
 
Updated: Jul 25, 2016
 

Medication Summary

If the tumor is secreting excess hormone (eg, prolactin, growth hormone, corticotropin, gonadotropins (rarely), thyroid-stimulating hormone [TSH] [rarely), initiate appropriate medical therapy as described in the articles on Acromegaly and Cushing disease. For the most common microadenoma, ie, prolactinomas, administer a dopaminergic drug such as bromocriptine or cabergoline (see Hyperprolactinemia).

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Dopamine agonists

Class Summary

Dopamine agonists directly stimulate dopamine receptors on the lactotrope. The dopaminergic neurons in the tuberoinfundibular process normally inhibit the secretion of prolactin from the anterior pituitary by secreting dopamine.In a study of 827 patients with hyperprolactinemia (81 of whom had macroadenomas), Corenblum found that treatment with bromocriptine normalized hyperprolactinemia in 85%, reversed symptoms in 93%, and reversed hypogonadism in 94%.[18] Similar results are reported with cabergoline, which has less intolerance and resistance.[19]

Bromocriptine (Parlodel)

 

Bromocriptine is a semisynthetic ergot alkaloid derivative, strong dopamine D2-receptor agonist, and partial dopamine D1-receptor agonist. It inhibits prolactin secretion with no effect on other pituitary hormones. It may be administered with food to minimize possibility of gastrointestinal irritation.

Cabergoline (Dostinex)

 

Cabergoline is a long-acting dopamine receptor agonist with a high affinity for D2 receptors. Prolactin secretion by the anterior pituitary is primarily under hypothalamic inhibitory control exerted through dopamine.

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Contributor Information and Disclosures
Author

Bernard Corenblum, MD, FRCPC Professor of Medicine, Director, Endocrine-Metabolic Testing and Treatment Unit, Ovulation Induction Program, Department of Internal Medicine, Division of Endocrinology, University of Calgary Faculty of Medicine, Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Acknowledgements

David M Klachko, MD, MEd Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Missouri-Columbia School of Medicine

David M Klachko, MD, MEd is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Federation for Medical Research, Missouri State Medical Association, Sigma Xi, and The Endocrine Society

Disclosure: Nothing to disclose.

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MRI showing a nonenhancing area in the pituitary consistent with a microadenoma in a patient with hyperprolactinemia.
 
 
 
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