Update in Pathogenesis, Diagnosis, and Therapy of Prolactinoma

Fukuhara, Noriaki; Nishiyama, Mitsuru; Iwasaki, Yoshinobu

doi:10.3390/cancers14153604

Cited by 24 publications

(9 citation statements)

References 81 publications

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“…The efficacy of surgical and radiation interventions in patients with prolactinomas requires further analysis. Recent research suggests that surgical intervention often produces better long-term remission rates compared with medical therapies for prolactinomas 37 . Despite these findings, these interventions are still invasive, and the success of the procedure can depend on the neurosurgeon’s skill as well as the size of the tumor.…”

Section: Discussionmentioning

confidence: 99%

Determining Ideal Management for Patients With Coexisting Prolactinomas and Psychiatric Symptoms: A Systematic Review

Paracha,

Durrani,

Vasireddy

et al. 2024

Journal of Psychiatric Practice

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Objective: Prolactinomas—pituitary tumors that overproduce prolactin—can cause various troublesome symptoms. Dopamine agonists (DAs) reduce prolactin production in the prolactin pathway, making them the first-line treatment for prolactinomas. However, the main side effect of DA treatment, hyperdopaminergia, is an explicit etiology for psychiatric side effects. Psychiatric conditions are often treated with dopamine antagonists, which can induce hyperprolactinemia. This presents a challenge for patients with both a prolactinoma and a preexisting psychiatric condition, as treatment of one condition could worsen the other. This review seeks to identify an adequate therapeutic regimen for patients with coexisting prolactinomas and psychiatric symptoms. Methods: This review examined PubMed citations from 1960 to 2023 published in English and involving human subjects. Case reports, case series, and cohort studies involving patients with concomitant prolactinomas and psychiatric symptoms, as validated by brain imaging, serologic prolactin levels, and medical history or chart reports of psychiatric symptoms, were included. Results: Thematic analysis included 23 reports involving 42 participants; 27 of the 42 patients experienced a significant reduction in prolactin levels and psychiatric symptoms (64%). Treatment of those 42 patients included discontinuing or altering antipsychotic/dopamine antagonist therapy or discontinuing DA therapy to reduce psychiatric symptoms, with surgery or radiation postpharmacotherapy as a last-line strategy. However, in some cases (reported in Tables 2 to 4), either psychiatric or prolactin-related symptoms recurred despite adjustment. Conclusions: Clinicians may find it beneficial to prioritize specific antipsychotics (aripiprazole, olanzapine, ziprasidone, or clozapine) over others (risperidone, thioridazine, thiothixene, and remoxipride). Discontinuing DA medication at least periodically until the patient’s condition improves may also be advisable. If these 2 initial approaches do not yield a significant improvement in symptom management, surgery or radiation therapy may be considered. As patients may respond differently to these therapies, our study still recommends a patient-centered approach.

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Section: Discussionmentioning

confidence: 99%

Determining Ideal Management for Patients With Coexisting Prolactinomas and Psychiatric Symptoms: A Systematic Review

Paracha,

Durrani,

Vasireddy

et al. 2024

Journal of Psychiatric Practice

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“…Radiation therapy, either fractionated external beam radiotherapy (EBRT), known as conventional radiotherapy, or stereotactic radiosurgery, may be effective for tumor control or shrinkage in patients for whom surgical intervention and dopamine agonist treatment fail, or for patients with an aggressive or malignant prolactinoma. However, the maximal effect may take several years to achieve, hypopituitarism may occur in a significant number of patients, and, albeit rarely, cranial nerve injury may develop or a second tumor may form [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

The Role of Aromatase Inhibitors in Male Prolactinoma

Akirov

Rudman

2023

JCM

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Background: dopamine agonists are the recommended treatment for male prolactinomas, but some patients may develop dopamine-agonist-resistant hyperprolactinemia, leading to persistent hypogonadism that requires treatment with testosterone. However, testosterone replacement therapy may be associated with a decrease in the efficacy of dopamine agonists due to the aromatization of testosterone to estradiol, which can stimulate the proliferation and hyperplasia of lactotroph cells in the pituitary, inducing resistance to dopamine agonists. Objective: this paper systematically reviewed the role of aromatase inhibitors for men with prolactinoma and dopamine-agonist-resistant or persistent hypogonadism following treatment. Method: we performed a systematic review of all studies (according to PRISMA guidelines), assessing the role of aromatase inhibitors, including anastrozole and letrozole, for male prolactinoma. An English-language search for relevant studies was conducted on PubMed from its inception to 1 December 2022. The reference lists of the relevant studies were also reviewed. Results: our systematic review identified six articles (nine patients), including five case reports and a single case series, on the use of aromatase inhibitors for male prolactinomas. Reducing estrogen levels with an aromatase inhibitor improved sensitivity to dopamine agonists, as the addition of anastrozole or letrozole improves the control of prolactin levels and may lead to the shrinkage of tumors. Conclusion: aromatase inhibitors are of potential value to patients with dopamine-agonist-resistant prolactinoma, or when hypogonadism persists while using high-dose dopamine agonists.

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“…The effectiveness of radiotherapy for prolactinoma treatment is doubtful and has minimal application ( 1 ). A small proportion of patients with prolactinomas are resistant to drug therapy (3%–12%) or do not tolerate the side effects of drugs (3%–11%) ( 20 , 21 ). In this group of patients with unsuccessful DA therapy, surgical treatment is recommended and postoperative permanent remission is about 72%, according to literature data ( 21 , 22 ).…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors for surgical treatment of prolactin-secreting pituitary adenomas

Voznyak,

Zinkevych,

Lytvynenko

et al. 2024

Front. Surg.

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IntroductionUsually, prolactinomas are treated with dopamine agonists (DA). Surgery is considered an option when the patient cannot bear or does not respond positively to DA therapy.AimThis study aims to determine the early and late outcomes of surgery, with particular emphasis on developing prognostic factors for surgical treatment and analyzing risk factors affecting the recurrence of hyperprolactinemia and prolactinoma.Material and methodsThis retrospective study was conducted at the Feofaniya Clinical Hospital of the State Administration of Affairs (Kyiv, Ukraine), evaluating 109 patients' records from 2009 to 2019. The main patients' inclusion criteria were: serum prolactin (PRL) level of more than 100 ng/ml, presence of pituitary adenoma (PA) on MRI, histologically approved PA by microscopy. According to the size of the prolactin-secreting PA (PSPAs) the selected 109 patients were divided into two groups: micro- (≤10 mm, n = 75) and macroadenoma group (10–40 mm, n = 34).Results1 month after the operation, PRL levels decreased by 87% (p < 0.001), 12 months—by 93% (p < 0.001). After receiving surgery and DA therapy for 12 months 77.1% of patients achieved biochemical remission. Out of the total number of patients observed, 15.6% (n = 17) had a Knosp score greater than 3. Additionally, in the macroadenoma group, the percentage of patients with a Knosp score greater than 3 was 41,2%, which was significantly higher as compared to the microadenoma group (4%, p < 0.001). In patients with microadenomas a weak reverse correlation between patients' age (r = −0.258, p < 0.026) and positive with tumor size (r = 0.251, p < 0.030) was revealed. In the macroadenoma group significant association was found only between preoperative serum PRL level and tumor size (r = 0.412, p < 0.016). The preoperative PRL can be used as a diagnostic marker for lack of early biochemical remission in patients with PSPAs with diagnostic accuracy 66.9%.ConclusionsThis study found that primary transsphenoidal surgery is an effective treatment in reaching PRL level control in patients with both micro- and macroprolactinomas. The correct and thorough selection of candidates for surgery is crucial to achieve postoperative serum PRL normalization in the vast majority of patients.

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Update in Pathogenesis, Diagnosis, and Therapy of Prolactinoma

Cited by 24 publications

References 81 publications

Determining Ideal Management for Patients With Coexisting Prolactinomas and Psychiatric Symptoms: A Systematic Review

Determining Ideal Management for Patients With Coexisting Prolactinomas and Psychiatric Symptoms: A Systematic Review

The Role of Aromatase Inhibitors in Male Prolactinoma

Prognostic factors for surgical treatment of prolactin-secreting pituitary adenomas

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