Contemporary management of prolactinomas

Abstract

<jats:p>Prolactin-secreting pituitary adenomas—prolactinomas—are the most common type of functional pituitary tumor. Treatment of hyperprolactinemia is indicated because of the consequences of infertility, gonadal dysfunction, and osteoporosis. Making the correct diagnosis is important because the first line of therapy is medical management with dopamine agonists. Medical therapy is effective in normalizing prolactin levels in more than 90% of patients, but long-term treatment may be required in some patients. Transsphenoidal surgery is usually indicated in those patients in whom medical therapy fails or cannot be tolerated, or in patients who harbor microprolactinomas. In experienced hands, a hormonal and oncological cure can be achieved in more than 90% of patients after transsphenoidal removal of microprolactinomas with minimal risks. Thus, surgery may be an option for microprolactinomas in a young patient who desires restoration of fertility and avoidance of long-term medical therapy. The authors review the diagnosis and management of prolactinomas, including medical therapy, surgical therapy, and stereotactic radiosurgery.</jats:p>

Diagnosis and management of pituitary tumours in the elderly: a review based on personal experience and evidence of literature

“…In contrast, most authors agree to consider surgery as a second choice of treatment for patients with prolactinoma at any age, when DAs prove to be inefficient or badly tolerated, even though some advocate TSS for microprolactinomas when conditions for definitive cure are fulfilled (57). However, surgery for microprolactinomas would be highly questionable in the elderly, since hyperprolactinaemia itself is poorly symptomatic.…”

“…However, surgery for microprolactinomas would be highly questionable in the elderly, since hyperprolactinaemia itself is poorly symptomatic. On the other hand, macroprolactinomas are poorly controlled by TSS (57), and this seems to be especially true in the elderly (4,6,7). We have thus progressively abandoned TSS as a debulking option in these patients, and further limited surgical indications to resistant macroprolactinomas with visual defects or clear radiological evidence of tumour progression.…”

Surgical outcomes and prognostic factors of transsphenoidal surgery for prolactinoma in men: a single-center experience with 87 consecutive cases

“…In our study, no important influence of preoperative DA administration on surgical outcomes was found. Furthermore, most studies including the present data found that tumor cytoreduction after surgery typically elevates the responsiveness of DA and hence decreases the required dosage, even if surgery is not curative (36,37).…”

Update on prolactinomas. Part 2: Treatment and management strategies

“…Prolactinomas are the most common hormone-secreting pituitary tumors, accounting for approximately 40% of all pituitary tumors and 50-60% of all functional pituitary tumors [1][2][3]. Patients typically present with clinical features of hyperprolactinemia, including gonadal dysfunction, amenorrhea and galactorrhea.…”