<i>JCEM ARCHIVE</i>Diagnosis and Treatment of Hyperprolactinemia: An Endocrine Society Clinical Practice Guideline

Мелмед, Шломо; Casanueva, Felipe F.; Hoffman, Andrew R.; Kleinberg, David L.; Montori, Víctor M.; Schlechte, Janet A.; Wass, John

doi:10.1210/dde1.9781936704583.jcem03

Cited by 21 publications

(89 citation statements)

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“…A single venipuncture obtained in minimized stress conditions suffices for blood sampling for measurement of prolactin (Melmed et al, 2011). Alternatively, in cases of doubt, two samples can be taken 15 minutes apart using a cannula to be sure that the second sample is obtained in a pain-free manner.…”

Section: Laboratoryassessment Of Hyperprolactinemiamentioning

confidence: 99%

“…However, long term follow-up of patients with macroprolactinemia and normal concentrations of monomeric prolactin did not reveal symptomatic progression (Wallace et al, 2010). Precipitation of macroprolactin with polyethylene glycol (PEG) is currently used to screen for the presence of circulating macroprolactin (Leslie et al, 2001;Melmed et al, 2011).…”

Section: Macroprolactinemiamentioning

confidence: 99%

“…These hook effects differ between the different assay systems used in clinical practice. Dilution of the sample 1:100 is the test of choice to unmask this hook effect (Melmed et al, 2011). Since it is very unpractical to do this in all samples offered for prolactin analysis, the clinician should consider this possibility in macroadenomas.…”

Section: High-dose Hook Effectmentioning

confidence: 99%

“…There are no indications for testing patients with hyperprolactinemia with TRH or dopamine agonists (Melmed et al, 2011). In case a macroprolactinoma or another pathologic cause of hyperprolactinemia is considered, other pituitary functions should be assessed appropriately, since mass effects may result in varying degrees of hypopituitarism.…”

Section: Dynamic Tests Of Prolactin Secretionmentioning

confidence: 99%

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Hyperprolactinemia and prolactinoma

Romijn

2014

Handbook of Clinical Neurology

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Section: Laboratoryassessment Of Hyperprolactinemiamentioning

confidence: 99%

Section: Macroprolactinemiamentioning

confidence: 99%

Section: High-dose Hook Effectmentioning

confidence: 99%

Section: Dynamic Tests Of Prolactin Secretionmentioning

confidence: 99%

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Hyperprolactinemia and prolactinoma

Romijn

2014

Handbook of Clinical Neurology

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“…6 in line with recommendations published in the Endocrine Society Clinical Practice Guidelines, patients who are intolerant or resistant to one or more dopamine agonists normally proceed to surgery, the second-line treatment, and frequently to radiotherapy. 7 Aggressive atypical pituitary tumors tend to be large, invasive, and hyperangiogenic with high mitotic indices, which makes their treatment difficult. They have a tendency to grow continuously and frequently show resistance to dopamine agonist therapy.…”

mentioning

confidence: 99%

Temozolomide therapy for resistant prolactin-secreting pituitary adenomas and carcinomas: a systematic review

Almalki

Aljoaib

Alotaibi

et al. 2017

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Pituitary tumors represent 10-15% of all intracranial tumors; of these, prolactinomas account for 40-50% of cases. Prolactinomas usually respond well to dopamine agonists (DA) as firstline therapy. However, treatment resistance remains a concern. Temozolomide (TMZ) is an oral alkylating agent that has shown promise in treating aggressive pituitary adenomas and carcinomas that are resistant to other therapies. To date, no control trials have been undertaken and only single case reports of pituitary tumors treated with TMZ have been published. A systematic literature search was conducted for studies reporting the use of TMZ for the treatment of prolactinomas that were resistant to standard therapy. In total, 42 reported cases were identified and included in our analysis: 23 cases of prolactin-secreting adenomas and 19 of prolactin-secreting carcinomas. Prior to TMZ administration, patients had exhibited tumor progression and had previously undergone various treatments including surgery, radiotherapy, and drug therapy. Tumor shrinkage was reported in 76% of patients. Reduced prolactin levels were observed in 75% of patients, while normalization of prolactin was reported in 8%. TMZ failure occurred in 20.6% of cases. Most patients exhibited no serious adverse effects. In conclusion, TMZ has potential for the treatment of highly aggressive and resistant prolactin-secreting adenomas and carcinomas, as demonstrated by tumor shrinkage or complete response and normalization of hormone hypersecretion, and exhibits good tolerability and few side effects.

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Diagnosis and Treatment of Pituitary Adenomas

Molitch

2017

JAMA

782

578

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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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JCEM ARCHIVEDiagnosis and Treatment of Hyperprolactinemia: An Endocrine Society Clinical Practice Guideline

Cited by 21 publications

References 0 publications

Hyperprolactinemia and prolactinoma

Hyperprolactinemia and prolactinoma

Temozolomide therapy for resistant prolactin-secreting pituitary adenomas and carcinomas: a systematic review

Diagnosis and Treatment of Pituitary Adenomas

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