How should I manage a patient with a prolactin-secreting pituitary adenoma who is experiencing symptoms of hyperprolactinemia?

Management of a patient with a prolactin-secreting pituitary adenoma presenting with symptoms of hyperprolactinemia should begin with confirming the diagnosis through serum prolactin measurement and pituitary imaging to assess tumour size and invasiveness. The first-line treatment is medical therapy with dopamine agonists, such as cabergoline or bromocriptine, which effectively reduce prolactin levels, shrink the adenoma, and alleviate symptoms of hyperprolactinemia. Treatment should be initiated and titrated carefully to balance efficacy and tolerability, monitoring for side effects and prolactin response.

If the patient experiences intolerance or adverse effects to dopamine agonists, recent evidence suggests strategies such as dose adjustment, switching between dopamine agonists, or adjunctive therapies may be considered to improve tolerability while maintaining control of hyperprolactinemia (Stumpf et al., 2023). Surgical intervention is reserved for patients who are resistant or intolerant to medical therapy or have compressive symptoms not relieved by medication. Regular follow-up with clinical assessment, prolactin levels, and imaging is essential to monitor treatment response and detect recurrence.