Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas

Casanueva, Felipe F.; Molitch, Mark E.; Schlechte, Janet A.; Abs, Roger; Bonert, Vivien; Bronstein, Marcello D.; Brue, Thierry; Cappabianca, Paolo; Colao, Annamaria; Fahlbusch, Rudolf; Fideleff, Hugo; Hadani, Moshe; Kelly, Paul A.; Kleinberg, David L.; Laws, Edward R.; Jakóbisiak, Marek; Scanlon, M. F.; Sobrinho, L. G.; Wass, John; Giustina, Andrea

doi:10.1111/j.1365-2265.2006.02562.x

Cited by 712 publications

(675 citation statements)

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“…Magnetic resonance imaging (MRI) was performed on all patients before surgery. Based on the largest diameter measured by preoperative MRI, tumors fell into two categories: microadenomas and macroadenomas (20). The latter was subdivided into intrasellar and extrasellar macroadenomas (16).…”

Section: Patientsmentioning

confidence: 99%

“…The diagnosis of prolactinomas was postoperatively confirmed by immunohistochemical analysis. Indications for surgical therapy of prolactinomas are currently as follows: resistance to medical therapy, intolerance to DA, neurological deficits including rapid visual loss or cranial nerve palsies because of tumor apoplexy, cerebrospinal fluid leakage attributable to tumor shrinkage after medical therapy, cystic macroprolactinomas with neurological symptoms, and patient preference (17,20). Of the 87 patients, 24 cases underwent surgery due to intolerance to DA, 15 due to resistance to DA, 9 cases because of tumor apoplexy causing neurological symptoms, and the other due to personal preference.…”

Section: Patientsmentioning

confidence: 99%

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

Qu¹,

Wang²,

Wang³

et al. 2011

European Journal of Endocrinology

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Context: Little systematic data on male prolactinomas treated with surgery are available. Objective: To clarify the clinical features and confirm the efficacy of transsphenoidal surgery for male prolactinomas and predictive factors after initial surgery. Patients and methods: This retrospective study included 87 male patients with prolactinoma treated by transsphenoidal surgery at an academic medical center. Hormonal and visual status, remission rates, and the rate of tumor relapse, as well as predictive factors, were evaluated. Results: Postoperative initial remission was achieved in 52.9% of patients. The remission rate was markedly higher in microadenomas (83.3%) than in macroadenomas (44.9%). Logistic regression analysis showed that the predictive factors of the early negative outcomes were high preoperative prolactin (PRL) levels and tumor invasion. After a median follow-up of 45 months, the long-term remission rate was 42.5%, and relapse of hyperprolactinemia occurred in 19.6% of the cured patients. The 5-year recurrence-free survival was 78.2% (95% confidence interval, 62.3-88.1%). When surgery was followed by adjuvant treatment in uncured and recurrent patients, 78.8% of patients in the entire group in the absence of dopamine agonists obtained biochemical remission at the end of follow-up. Conclusion: Transsphenoidal surgery is a viable treatment alternative for male prolactinomas. The remission rates of male patients with microadenomas and/or intrasellar macroprolactinomas by surgery alone remain excellent, and surgery followed by adjuvant therapy as necessary is required for optimizing management of male prolactinomas, especially for extrasellar macroprolactinomas. The early negative results are associated with preoperative PRL levels and tumor invasion.

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Section: Patientsmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

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

Qu¹,

Wang²,

Wang³

et al. 2011

European Journal of Endocrinology

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“…In every case, situations associated with false-positive GH and IGF-1 results were excluded (pregnancy, thyroid dysfunction, puberty, malnutrition, diabetes, kidney or liver disease, and drugs including anovulatory agents, estrogens or corticosteroids). After this step, laboratory anomalies were interpreted as follows (1,(7)(8)(9). The diagnosis of biochemically active acromegaly was unequivocal (elevated IGF-1 for gender and age with nadir GH > 1 µg/L) in two patients (patients 1 and 10 in table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Investigation for acromegaly should be performed in the presence of a suggestive phenotype or of an adenoma unlikely to be a prolactinoma (7)(8)(9), which is suspected in the presence of moderate hyperprolactinemia associated with non-cystic macroadenoma or in the absence of marked tumor reduction after some months of dopaminergic agonist treatment and normalization of PRL (1). Investigation of acromegaly is not recommended in the remaining cases (1).…”

Section: Discussionmentioning

confidence: 99%

“…When patients with prolactinoma and co-secretion of GH are treated with dopaminergic agonists, normalization of PRL accompanied by the remission of hyperprolactinemia symptoms is the rule (1). Difficulties lie in that the same response is not observed for GH and insulin-like growth factor 1 (IGF-1) in a marked proportion of patients (4)(5)(6), with persistence of hypersecretion of these hormones.…”

Section: Introductionmentioning

confidence: 99%

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Biochemical acromegaly in patients with prolactinoma during treatment with dopaminergic agonists

Rosário

Purisch

2010

Arq Bras Endocrinol Metab

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Objective: To evaluate the frequency of subclinical acromegaly (in the absence of clinical phenotype but biochemically uncontrolled) in patients with prolactinoma during treatment with dopaminergic agonists. Subjects and methods: One hundred twenty one patients without a phenotype suggestive of acromegaly were studied. Results: Initially, the laboratory diagnosis of acromegaly was unequivocal (elevated IGF-1 for gender and age with nadir GH > 1 µg/L) in two patients, and likely (elevated IGF-1 with nadir GH > cut-off but < 1 µg/L) in another patient. In two other patients, this diagnosis was possible (normal IGF-1 with nadir GH > 1 µg/L). Repetition of the tests 6 months after withdrawal of the dopaminergic agonist confirmed the diagnosis of subclinical acromegaly (elevated IGF-1 for gender and age with nadir GH > 1 µg/L) in these 5 patients. False-positive results were excluded in all cases. Conclusion: In patients with prolactinomas, acromegaly should be investigated not only in cases with a clinical phenotype. Arq Bras Endocrinol Metab. 2010;54(6):546-9 Keywords Acromegaly; prolactinoma; growth hormone; IGF-1 RESUMO Objetivo: Avaliar a frequência de acromegalia subclínica (na ausência de fenótipo clínico, mas bioquimicamente não controlada) em pacientes com prolactinoma em tratamento com agonistas dopaminérgicos. Sujeitos e métodos: Cento e vinte e um pacientes sem fenótipo de acromegalia foram estudados. Resultados: Inicialmente, o diagnóstico laboratorial de acromegalia foi inequívoco (IGF-1 elevado para sexo e idade com nadir do GH > 1 µg/L) em dois pacientes, e provável (IGF-1 elevado com nadir do GH > valor de corte ensaio-específico mas < 1 µg/L) em outro paciente. Em outros dois, esse diagnóstico foi possível (IGF-1 normal com nadir do GH > 1 µg/L). A repetição dos testes seis meses após a suspensão dos agonistas dopaminérgicos confirmou o diagnóstico de acromegalia subclínica (IGF-1 elevado para sexo e idade com nadir do GH > 1 µg/L) em cinco desses pacientes. Os resultados falso-positivos foram excluídos em todos os casos. Conclusão: Em pacientes com prolactinomas, a acromegalia deveria ser investigada não apenas nos casos com fenótipo clínico. Arq Bras Endocrinol Metab. 2010;54(6):546-9 Descritores Acromegalia; prolactinoma; hormônio de crescimento; IGF-1

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Diagnosis and Treatment of Pituitary Adenomas

Molitch

2017

JAMA

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pproximately 10% of unselected pituitaries (meaning those from individuals without known pituitary disease) examined at autopsy contain pituitary adenomas. 1 Magnetic resonance imaging (MRI) scans of normal volunteers also show a 10% prevalence, 2 but other pathologic entities may have a similar appearance, such as Rathke cleft cysts and metastatic tumors. 3 Not all patients with pituitary tumors develop symptoms because most tumors remain small and most do not secrete hormones in excessive amounts. Clinical case-finding studies, in which all hospitals and practices in a geographic area were queried about cases with pituitary tumors over a defined period, have suggested a prevalence of pituitary adenoma ranging from 1 in 865 persons to 1 in 2688 persons (Table 1). 4,[6][7][8][9][10][11] Pituitary adenomas are classified into microadenomas (<10 mm), macroadenomas (Ն10 mm), and giant adenomas (Ն40 mm) (Figure 1). 12,13 Pituitary carcinomas with distant metastases are rare, occurring in 0.1% to 0.2% of cases. 12 If an MRI shows the tumor impinging on the optic chiasm, then formal visual field testing is indicated. 13 An evaluation for hypopituitarism should be carried out in all patients with macroadenomas and even large (6-9 mm) microadenomas. 1 Diabetes insipidus is rarely seen with pituitary adenomas. 1 About two-thirds of pituitary adenomas may secrete excess hormones. In the studies 4,6-11 that included 1718 patients, about 50% of cases were macroadenomas and 32% to 66% of tumors were secreting prolactin, 14% to 54% were clinically nonfunction-IMPORTANCE Pituitary adenomas may hypersecrete hormones or cause mass effects. Therefore, early diagnosis and treatment are important.OBSERVATIONS Prevalence of pituitary adenomas ranges from 1 in 865 adults to 1 in 2688 adults. Approximately 50% are microadenomas (<10 mm); the remainder are macroadenomas (Ն10 mm). Mass effects cause headache, hypopituitarism, and visual field defects. Treatments include transsphenoidal surgery, medical therapies, and radiotherapy. Prolactinomas account for 32% to 66% of adenomas and present with amenorrhea, loss of libido, galactorrhea, and infertility in women and loss of libido, erectile dysfunction, and infertility in men; they are generally treated with the dopamine agonists cabergoline and bromocriptine. Growth hormone-secreting tumors account for 8% to 16% of tumors and usually present with enlargement of the lips, tongue, nose, hands, and feet and are diagnosed by elevated insulin-like growth factor 1 levels and growth hormone levels; initial treatment is surgical. Medical therapy with somatostatin analogues, cabergoline, and pegvisomant is often also needed. Adrenocorticotropic hormone (ACTH)-secreting tumors account for 2% to 6% of adenomas and are associated with obesity, hypertension, diabetes, and other morbidity. Measurement of a late-night salivary cortisol level is the best screening test but petrosal sinus sampling for ACTH may be necessary to distinguish a pituitary from an ectopic source. The primary treatment of Cushin...

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Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas

Cited by 712 publications

References 63 publications

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

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

Biochemical acromegaly in patients with prolactinoma during treatment with dopaminergic agonists

Diagnosis and Treatment of Pituitary Adenomas

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