Clinical management of difficult to treat macroprolactinomas

Abstract

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Treatment Strategies for Dopamine Agonist-Resistant and Aggressive Prolactinomas: A Comprehensive Analysis of the Literature

“…Prolactinomas are benign neoplasms (adenoma) that produce prolactin [2]. Prolactin can be secreted by various pituitary neuroendocrine tumors deriving either from somatotrophs or mammo-somatotroph cells besides the lactotroph cells [3]. Similarly, densely or sparsely granulated lactotroph tumors, poorly differentiated Pit1-lineage tumors and acidophil stem cell tumors can also cause hyperprolactinemia [3].…”

“…Prolactin can be secreted by various pituitary neuroendocrine tumors deriving either from somatotrophs or mammo-somatotroph cells besides the lactotroph cells [3]. Similarly, densely or sparsely granulated lactotroph tumors, poorly differentiated Pit1-lineage tumors and acidophil stem cell tumors can also cause hyperprolactinemia [3]. Prolactinomas -originating from lactotroph cells -are the most frequently hormone-secreting pituitary tumors (approximately 30-40 % of all pituitary tumors), and its prevalence is about 94 per 100 000 inhabitants [2].…”

“…Prolactinomas -originating from lactotroph cells -are the most frequently hormone-secreting pituitary tumors (approximately 30-40 % of all pituitary tumors), and its prevalence is about 94 per 100 000 inhabitants [2]. Prolactinomas are much more frequently diagnosed in female population with a sex ratio around 10:1 before the fifth decade, but after this age, the prolactinoma frequency is about the same in both gender [3]. This shows that female hormones may propagate prolactinoma growth; and indeed, there exist substantial evidence supporting this hypothesis, which will be discussed below.…”

“…Resistance to cabergoline is defined by the absence of prolactin normalization or lack of the tumor to reduce in size by 50 %, and these refractory prolactinomas tend to exert higher angiogenesis, cell proliferation and atypia and invasiveness [5]. Quinagolide is a non-ergot-derived D2R-selective agonist, which could provide significant reduction in tumor size and prolactin levels in around 90 % of patients [3]. Quinagolide is usually given at the average dose of 150 -300 μg/day and compared to bromocriptine, more prominent reduction in dizziness, nausea, vomiting, and drowsiness is generally witnessed [3].…”

“…Quinagolide is a non-ergot-derived D2R-selective agonist, which could provide significant reduction in tumor size and prolactin levels in around 90 % of patients [3]. Quinagolide is usually given at the average dose of 150 -300 μg/day and compared to bromocriptine, more prominent reduction in dizziness, nausea, vomiting, and drowsiness is generally witnessed [3].…”