In all patients with suspected pituitary tumors, a complete pituitary hormone evaluation should be performed. Therefore, other types of pituitary adenomas, craniopharyngiomas or other tumors or masses may cause modest elevations in prolactin. Imaging Most prolactinomas can be visualized on both MRI and CT scans of the pituitary gland. Such scans should be performed without and with contrast. In general, the first line of treatment for patients with a prolactinoma is medical rather than surgical.
Most women also have a return of menses and many become fertile again.
The size of the prolactinoma will be reduced in the majority of patients to varying degrees, which often results in improved vision and resolution of headaches. Bromocriptine is generally instituted slowly to minimize side effects. It is recommended that treatment be initiated with no more than one 2.5 mg tablet per day at mealtime. This will minimize the major side effect of nausea and gastrointestinal upset. The dose is then gradually increased over several days or weeks up to a daily maximum usually not exceeding 10 mgs.