Many patients taking medical therapy for a prolactinoma may assume that they need treatment for life. In reality it is often possible to stop treatment after a while.
In considering whether to stop treatment of a prolactinoma, it is helpful first to review the diagnosis and clarify whether the patient has a prolactinoma. Hyperprolactinaemia has many causes, and some patients are treated without a secure diagnosis of prolactinoma.
For a woman with a microprolactinoma, the usual aim is to allow normal ovarian function and so maintain a healthy degree of oestrogenisation. It follows that, after the menopause, there may be no benefit in treatment of hyperprolactinaemia.
For a patient with a macroprolactinoma, in whom treatment is reducing the size of the tumour and protecting vision, life-long treatment may be necessary. However, in some cases it is possible to reduce or stop treatment without a new threat to vision, for example after an episode of pituitary apoplexy causing infarction of the prolactinoma.
In considering whether to stop treatment of a prolactinoma it is helpful to take into account the size of the prolactinoma before treatment and the response to treatment, as these factors help predict the likely outcome of stopping treatment.
In principle patients should be treated for a prolactinoma for as long as they are deriving a clinical benefit from treatment. Where this may no longer be the case consideration should be given to stopping treatment. After stopping treatment a period of follow-up is important to determine whether it is appropriate for the patient to continue without treatment.
07 Nov 2016 - 09 Nov 2016