Medical and surgical management of microprolactinoma

A recent report by Colao et al. [1] indicates that a significant proportion of patients harboring prolactinomas treated with cabergoline will have persistence of remission of hyperprolactinemia following withdrawal of the drug. The prolactin and tumor control rates in the study suggest that medical therapy will become increasingly important for the management of all prolactinomas. Currently, surgery remains an option only for those patients in whom medical therapy has failed or in those with microadenomas. The recent results from Colao et al. [1] demonstrated an impressive 70% cure rate following cabergoline treatment of microprolactinomas; these findings are likely to further reduce the number of patients seeking surgical treatment [2]. Several factors, however, must be considered in the determination to use medical therapy for prolactinomas. In addition to control rate, factors such as the patient's medical history, personal preference and the cost of treatment should be considered. The authors have undertaken a simple comparative study of the relative cost and efficacy of medical or surgical management in those patients with microprolactinomas.