Treatments for pituitary tumors include either surgery or therapeutic treatment with a dopamine agonist. Although radiation therapy is still an option, it is rarely used in patients with prolactinomas, particularly those with microadenomas. If the tumor is large but nonfunctional, surgery is indicated. Surgery on functioning prolactin-secreting tumors does not reliably result in a long-term cure, and recurrence of hyperprolactinemia is common. If the tumor secretes prolactin, the treatment of choice is a dopamine agonist. In the United States, two drugs are approved for the treatment of hyperprolactinemia: bromocriptine, an ergot derivative; and cabergoline, a nonergot agonist. Bromocriptine has been the most commonly used agent for many years. Recently, cabergoline was introduced. It is better tolerated by patients and has an extremely long half-life, requiring only a single weekly dose compared to the 1-3 times daily administration of bromocriptine.
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