**Table 4.**

*Bromocriptine and cabergoline specifications.*

#### *Pituitary Adenomas: Classification, Clinical Evaluation and Management DOI: http://dx.doi.org/10.5772/intechopen.103778*

with microadenomas, risk of microadenoma progression is low and prolactin level monitoring is not necessary [15].

Macroadenomas always need management. Bromocriptine should be the drug of choice for patients who need fertility restoration. Pregnant women with macroadenoma without extrasellar extension can be followed similarly as microadenoma patients. However, if the suprasellar extension was detected before pregnancy, tumor debulking is advisable as the risk of macroadenoma growth during pregnancy is up to 35% [15, 16]. In these patients, it is also prudent to have a visual field assessment every 3 months till delivery.

Surgical management of prolactinoma is indicated in patients who are nonresponders to dopaminergic therapy, with intolerable adverse effects from medical therapy (e.g. bromocriptine), CSF fistulas under DA, cystic tumors with intramural hemorrhage, or progressive neurological deficits [11, 17]. Stable visual field defect is not considered an indication for surgery as most patients will have tumor shrinkage on medical therapy with improvement on visual symptoms.

When to consider a prolactinoma as being medication resistant?


Seventy-percent of bromocriptine resistant patients will respond on cabergoline. Around 10–16% of prolactinoma patients will need surgical management [11]. Most patients will have a reduction of PRL levels 2–3 weeks after dopamine agonist initiation, which generally precedes the tumor size reduction. Periodic PRL measurements and pituitary MRI every 6–12 months is advised. After 2 years of continuous therapy, if prolactin levels have been normalized and >50% reduction of tumor size has been achieved, medication dose can be reduced. Typically, a low-dose of dopamine agonist after 2 years of tumor control will usually keep prolactin within normal range and prevent tumor recurrence [18].
