Treatment of Prolactinoma
Prolactinomas are the commonest form of pituitary neuroendocrine tumor (PitNET), representing approximately half of such tumors. Dopamine agonists (DAs) have traditionally been the primary treatment for the majority of prolactinomas, with surgery considered the second line. The aim of this review is...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-08-01
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| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1648-9144/58/8/1095 |
| _version_ | 1797431963808694272 |
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| author | Warrick J. Inder Christina Jang |
| author_facet | Warrick J. Inder Christina Jang |
| author_sort | Warrick J. Inder |
| collection | DOAJ |
| description | Prolactinomas are the commonest form of pituitary neuroendocrine tumor (PitNET), representing approximately half of such tumors. Dopamine agonists (DAs) have traditionally been the primary treatment for the majority of prolactinomas, with surgery considered the second line. The aim of this review is to examine the historical and modern management of prolactinomas, including medical therapy with DAs, transsphenoidal surgery, and multimodality therapy for the treatment of aggressive prolactinomas and metastatic PitNETs, with an emphasis on the efficacy, safety, and future directions of current therapeutic modalities. DAs have been the mainstay of prolactinoma management since the 1970s, initially with bromocriptine and more recently with cabergoline. Cabergoline normalizes prolactin in up to 85% of patients and causes tumor shrinkage in up to 80%. Primary surgical resection of microprolactinomas and enclosed macroprolactinomas performed by experienced pituitary neurosurgeons have similar remission rates to cabergoline. Aggressive prolactinomas and metastatic PitNETS should receive multimodality therapy including high dose cabergoline, surgery, radiation therapy (preferably using stereotactic radiosurgery where suitable), and temozolomide. DAs remain a reliable mode of therapy for most prolactinomas but results from transsphenoidal surgery in expert hands have improved considerably over the last one to two decades. Surgery should be strongly considered as primary therapy, particularly in the setting of microprolactinomas, non-invasive macroprolactinomas, or prior to attempting pregnancy, and has an important role in the management of DA resistant and aggressive prolactinomas. |
| first_indexed | 2024-03-09T09:52:55Z |
| format | Article |
| id | doaj.art-77baf5c15bbc4aae93541875a8e966b0 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-09T09:52:55Z |
| publishDate | 2022-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-77baf5c15bbc4aae93541875a8e966b02023-12-01T23:58:47ZengMDPI AGMedicina1010-660X1648-91442022-08-01588109510.3390/medicina58081095Treatment of ProlactinomaWarrick J. Inder0Christina Jang1Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Woolloongabba 4102, AustraliaDepartment of Endocrinology and Diabetes, Royal Brisbane and Women’s Hospital, Herston 4029, AustraliaProlactinomas are the commonest form of pituitary neuroendocrine tumor (PitNET), representing approximately half of such tumors. Dopamine agonists (DAs) have traditionally been the primary treatment for the majority of prolactinomas, with surgery considered the second line. The aim of this review is to examine the historical and modern management of prolactinomas, including medical therapy with DAs, transsphenoidal surgery, and multimodality therapy for the treatment of aggressive prolactinomas and metastatic PitNETs, with an emphasis on the efficacy, safety, and future directions of current therapeutic modalities. DAs have been the mainstay of prolactinoma management since the 1970s, initially with bromocriptine and more recently with cabergoline. Cabergoline normalizes prolactin in up to 85% of patients and causes tumor shrinkage in up to 80%. Primary surgical resection of microprolactinomas and enclosed macroprolactinomas performed by experienced pituitary neurosurgeons have similar remission rates to cabergoline. Aggressive prolactinomas and metastatic PitNETS should receive multimodality therapy including high dose cabergoline, surgery, radiation therapy (preferably using stereotactic radiosurgery where suitable), and temozolomide. DAs remain a reliable mode of therapy for most prolactinomas but results from transsphenoidal surgery in expert hands have improved considerably over the last one to two decades. Surgery should be strongly considered as primary therapy, particularly in the setting of microprolactinomas, non-invasive macroprolactinomas, or prior to attempting pregnancy, and has an important role in the management of DA resistant and aggressive prolactinomas.https://www.mdpi.com/1648-9144/58/8/1095prolactinomadopamine agonisttranssphenoidal surgerytemozolomidestereotactic radiosurgery |
| spellingShingle | Warrick J. Inder Christina Jang Treatment of Prolactinoma Medicina prolactinoma dopamine agonist transsphenoidal surgery temozolomide stereotactic radiosurgery |
| title | Treatment of Prolactinoma |
| title_full | Treatment of Prolactinoma |
| title_fullStr | Treatment of Prolactinoma |
| title_full_unstemmed | Treatment of Prolactinoma |
| title_short | Treatment of Prolactinoma |
| title_sort | treatment of prolactinoma |
| topic | prolactinoma dopamine agonist transsphenoidal surgery temozolomide stereotactic radiosurgery |
| url | https://www.mdpi.com/1648-9144/58/8/1095 |
| work_keys_str_mv | AT warrickjinder treatmentofprolactinoma AT christinajang treatmentofprolactinoma |