Will a prolactinoma shrink for a patient in his 70s after increasing the dose of Cabergoline?

Q. Does a patient with prolactinoma require cortisol before undergoing pituitary surgery?

Answered by
Dr. Shaikh Sadaf
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 08, 2022

Hello doctor,

I would appreciate your opinion about a case in which pituitary surgery has been indicated. A patient in his early 70s was diagnosed with a prolactinoma ten years ago. He was prescribed a tablet of Dostinex 0.5 mg per week, which was then reduced to 0.5 mg per two weeks. The prolactin levels went down, but tumor size was slowly increasing. He was evaluated this month, but his prolactin levels are still low, and the optic chiasma compression affects the visual fields. I would like to know if we can assume that his adenoma is drug-resistant even though the maximum dosage reported in the literature is 3.5 mg of Cabergoline per week. As his prolactin levels are low, will the tumor shrink on increasing the dose? The patient took a tablet of Sotalol and had a history of Wolf-Parkinson-White syndrome.

Thank you.



Welcome to icliniq.com

Pituitary surgery is rarely required in prolactinomas and is generally reserved for patients intolerant or resistant to Dopamine agonist therapy, Cabergoline. Surgery is indicated only if visual field defects, headaches, and hypopituitarism are present. In addition, the tumor is resistant to the drug, so there will not be any benefit in increasing the drug dose.

Thank you doctor for the reply,

I would like to know if Cortisol is required before surgery, as they usually inject Hydrocortisone right before surgery, and dosage might depend on initial levels.

Thank you.



Welcome back to icliniq.com

It depends on the decision of your endocrine surgery team. Unfortunately, I am unaware of the patient's Adrenocorticotropic hormone (ACTH) and other pituitary hormone levels, so I might not be in a better position to judge the cortisol requirements at this point.

Thank you.

Was this answer helpful?


Same symptoms doesn’t mean you have the same problem. Consult a doctor now!

Related Questions:
All my reports are normal but I still have gynecomastia. What could be the reason?

I was treated with cabergoline and hydrocortisone for a few years and then taken off hydrocortisone when the adrenals began to function properly ...   Read full

I have high prolactin.Will this affect my fertility?

If prolactinoma (benign pituitary tumour that produces prolactin) has been ruled out on MRI then you may take tablet Cabergoline 025mg twice a week for 3 weeks and then evaluate your prolactin levels again .   Read full

Could you advise a possible treatment for my sleep problem?

.. limited history, two plausible causes of your insomnia can be made out. Cabergoline is a dopamine agonist, which has stimulating properties. However, you cannot quit taking it because it is needed in your case.   Read full

Also Read Answers From:

ideaComprehensive Medical Second Opinion.Submit your Case

Also Read

PCOS and Liver Problems
The hormonal imbalances in polycystic ovary syndrome could cause liver diseases. Read the article to know the relationship between these medical conditions.  Read more»
Inferior Alveolar Nerve Lateralization Technique
The inferior alveolar nerve lateralization technique is a surgical lateralization technique to reposition the nerve. Read the article to know more about this.  Read more»
COVID-19 and Ebola: Similarities and Differences
This article gives a comparison and broader overview of the outbreak of the two deadliest diseases that showed a greater incidence over the last two decades.  Read more»

Ask your health query to a doctor online?

Ask an Endocrinologist Now

* guaranteed answer within 4 hours.

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.