PRolaCT - Three Prolactinoma RCTs

Inclusion Criteria: * At least 18 years of age. * A history of signs and symptoms compatible with the diagnosis prolactinoma. * New, recent (PRolaCT-1) or known diagnosis of hyperprolactinaemia, defined as a prolactin level 2 times the local laboratory maximum. At the time of randomization hyperprolactinaemia is still present, or was present \< 12 months before inclusion (PRolaCT-2 and PRolaCT-3). * No clear alternative explanation for hyperprolactinaemia, e.g. medication use. * Presence of a clearly identifiable (persisting) pituitary mass on MRI not invading the cavernous sinus and having an optimal chance to be completely resected (generally adenomas with a maximum diameter nog exceeding 25mm). A representative MRI at the time of randomization is required, this MRI should generally not be older than 12 months in PRolaCT-3 and 2 months in PRolaCT-1 and PRolaCT-2. * Competent and able to fill in questionnaires. * One of the following, dividing patients in to our three RCTs: * PRolaCT-1: no prior treatment for prolactinoma; * PRolaCT-2: treatment with a dopamine agonist for 4-6 months; or * PRolaCT-3: treatment with a dopamine agonist for at least 2 years. Exclusion Criteria: * Contraindication for one of the treatment modalities, e.g. severe side effect of cabergoline, contraindications to surgery, or a clear indication for surgical resection. * Pregnancy at the time of randomization. * Clinical acromegaly. * Prior pituitary gland surgery or radiotherapy to the pit…