Dopamine Agonist-Resistant Microprolactinoma—Mechanisms, Predictors and Management: A Case Report and Literature Review

Szmygin, Hanna; Szydełko, Joanna; Matyjaszek‐Matuszek, Beata

doi:10.3390/jcm11113070

Cited by 7 publications

(8 citation statements)

References 30 publications

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“…After reviewing surgical notes, we found the PS texture of DA-treated tumor was mostly firm and closely adhered to the surrounding tissue, especially to the medial wall of the cavernous sinus. In contrast, other analyses have noted improved outcomes when patients were treated with bromocriptine before surgery [10,[26][27][28][29]. Whether therapy with a dopamine agonist exerts a negative effect on surgical outcome remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Extra-Pseudocapsular Transsphenoidal Surgery for Microprolactinoma in Women

Chen

Guo

Zhang

et al. 2022

JCM

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A recall for histological pseudocapsule (PS) and reappraisal of transsphenoidal surgery (TSS) as a viable alternative to dopamine agonists in the treatment algorithm of prolactinomas are getting vibrant. We hope to investigate the effectiveness and risks of extra-pseudocapsular transsphenoidal surgery (EPTSS) for young women with microprolactinoma, and to look into the factors that influenced remission and recurrence, and thus to figure out the possible indication shift for primary TSS. We proposed a new classification method of microprolactinoma based on the relationship between tumor and pituitary position, which can be divided into hypo-pituitary, para-pituitary and supra-pituitary groups. We retrospectively analyzed 133 patients of women (<50 yr) with microprolactinoma (≤10 mm) who underwent EPTSS in a tertiary center. PS were identified in 113 (84.96%) microadenomas intraoperatively. The long-term surgical cure rate was 88.2%, and the comprehensive remission rate was 95.8% in total. There was no severe or permanent complication, and the surgical morbidity rate was 4.5%. The recurrence rate with over 5 years of follow-up was 9.2%, and a lot lower for the tumors in the complete PS group (0) and hypo-pituitary group (2.1%). Use of the extra-pseudocapsule dissection in microprolactinoma resulted in a good chance of increasing the surgical remission without increasing the risk of CSF leakage or endocrine deficits. First-line EPTSS may offer a greater opportunity of long-term cure for young female patients with microprolactinoma of hypo-pituitary located and Knosp grade 0-II.

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Section: Discussionmentioning

confidence: 99%

Extra-Pseudocapsular Transsphenoidal Surgery for Microprolactinoma in Women

Chen

Guo

Zhang

et al. 2022

JCM

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“…Numerous studies utilizing fMRI have consistently linked obesity to altered structure and connectivity of the central nervous system, heightened motivation to eat, and impaired self‐control and reward processes related to food (Lizarbe et al., 2020; Szmygin et al., 2023). Research has shown that food intake in obese individuals is more driven by self‐reward rather than homeostatic demands (Sewaybricker et al., 2021).…”

Section: Neuroimaging Technologies For Food Sensory and Consumer Rese...mentioning

confidence: 99%

An advance in novel intelligent sensory technologies: From an implicit‐tracking perspective of food perception

Zhao,

Ye,

Deng

et al. 2024

Comp Rev Food Sci Food Safe

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Food sensory evaluation mainly includes explicit and implicit measurement methods. Implicit measures of consumer perception are gaining significant attention in food sensory and consumer science as they provide effective, subconscious, objective analysis. A wide range of advanced technologies are now available for analyzing physiological and psychological responses, including facial analysis technology, neuroimaging technology, autonomic nervous system technology, and behavioral pattern measurement. However, researchers in the food field often lack systematic knowledge of these multidisciplinary technologies and struggle with interpreting their results. In order to bridge this gap, this review systematically describes the principles and highlights the applications in food sensory and consumer science of facial analysis technologies such as eye tracking, facial electromyography, and automatic facial expression analysis, as well as neuroimaging technologies like electroencephalography, magnetoencephalography, functional magnetic resonance imaging, and functional near‐infrared spectroscopy. Furthermore, we critically compare and discuss these advanced implicit techniques in the context of food sensory research and then accordingly propose prospects. Ultimately, we conclude that implicit measures should be complemented by traditional explicit measures to capture responses beyond preference. Facial analysis technologies offer a more objective reflection of sensory perception and attitudes toward food, whereas neuroimaging techniques provide valuable insight into the implicit physiological responses during food consumption. To enhance the interpretability and generalizability of implicit measurement results, further sensory studies are needed. Looking ahead, the combination of different methodological techniques in real‐life situations holds promise for consumer sensory science in the field of food research.

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Section: Dopamine Agonist Resistancementioning

confidence: 99%

“…Moreover, it should be noted that currently there are no generally accepted criteria for DAs-resistance [ 10 , 12 ]. Most often, it is defined as the impossibility of achieving normoprolactinemia and reducing the maximum tumor diameter by less than 50% at the maximum tolerated doses of DAs for at least 3–6 months [ 10 , 12 , 13 ]. The doses vary widely in different patients, but are typically ≥ 15 mg bromocriptine per day, ≥ 2.0 mg cabergoline per week, and ≥ 225 μg quinagolide per day [ 10 ].…”

Section: Dopamine Agonist Resistancementioning

confidence: 99%

Current and Perspective Approaches to the Treatment of Prolactinomas

Barabash,

Tykhonova,

Kanishcheva

2023

AML

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Background: Along with the presence of the 2011 Endocrine Society Clinical Practice Guidelines and numerous large-scale studies on the treatment of hyperprolactinemia of different origin, there are some unresolved questions, ambiguous and sometimes contradictory points of view regarding the management of patients with prolactinomas. This overview is devoted to the analysis of the results of modern clinical studies and the approaches towards the management of hyperprolactinemia caused by prolactinoma.Materials and methods: A systematic research of the literature for the appropriate keywords published mainly for the last 10 years was done; also, a reference list of each selected article was analysed. We included to our review the articles reporting controversial issues or new data on the treatment of hyperprolactinemia.Results: The review describes various problems arising during the treatment of prolactinoma. The presence of primary and secondary dopamine agonist resistance in each case requires an individual approach, and sometimes may include the use of the antineoplastic agent temozolomide. The side effects of dopamine agonists are discussed, with quite rare ones, including valvulopathy, pathological psychological conditions and cerebrospinal rhinorrhea. The controversial issue of the duration and doses of the drug used to achieve a lasting effect in the treatment of prolactinomas is considered. There are some points connected with the frequency of relapses. Thus, recurrence is correlated to the duration of treatment with dopamine agonists, prolactin levels at diagnosis, and the initial tumor size. Metformin, somatostatin analogues, selective estrogen receptor modulators, tyrosine kinase inhibitors, inhibitors of the mammalian target of rapamycin, epidermal growth factor receptor antagonists are investigated nowadays as potential alternative methods of drug treatment of prolactinomas. Conclusion: Drug therapy with dopamine agonists makes it possible to achieve the desired results in the vast majority of patients. However, despite the proven safety of this group of medicines, the risk of side effects should still be taken into account. The therapy regimen should be determined by the clinical course of prolactinoma and the patient’s response to treatment. Other options of treatment should be considered in patients intolerant to medical therapy, with contraindication or resistance to dopamine agonists, in the case of a malignant tumor. The presence of refractory to any of the applied methods of treatment and aggressive prolactinomas leads to the search for new drugs.

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Dopamine Agonist-Resistant Microprolactinoma—Mechanisms, Predictors and Management: A Case Report and Literature Review

Cited by 7 publications

References 30 publications

Extra-Pseudocapsular Transsphenoidal Surgery for Microprolactinoma in Women

Extra-Pseudocapsular Transsphenoidal Surgery for Microprolactinoma in Women

An advance in novel intelligent sensory technologies: From an implicit‐tracking perspective of food perception

Current and Perspective Approaches to the Treatment of Prolactinomas

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