Management of cystic prolactinomas: a review

Nakhleh, Afif; Shehadeh, Naim; Hochberg, Irit; Zloczower, Moshe; Zolotov, Sagit; Taher, Riad; Naccache, Deeb Daoud

doi:10.1007/s11102-018-0888-0

Cited by 17 publications

(18 citation statements)

References 16 publications

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“…Surgery could be considered for prolactinomas where maximum doses of DA are not effective or tolerated, for those presenting with pituitary apoplexy with visual deterioration, when there are cystic tumour components compressing the visual pathway, or if cerebrospinal fluid leak develops [25,43,110,111,113]. Surgery may also be an option for young patients with microprolactinoma, as this may be a more cost-effective approach compared with lifelong DA therapy [114].…”

Section: Surgerymentioning

confidence: 99%

Hyperprolactinaemia

Samperi

Lithgow

Karavitaki

2019

JCM

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Hyperprolactinaemia is one of the most common problems in clinical endocrinology. It relates with various aetiologies (physiological, pharmacological, pathological), the clarification of which requires careful history taking and clinical assessment. Analytical issues (presence of macroprolactin or of the hook effect) need to be taken into account when interpreting the prolactin values. Medications and sellar/parasellar masses (prolactin secreting or acting through "stalk effect") are the most common causes of pathological hyperprolactinaemia. Hypogonadism and galactorrhoea are well-recognized manifestations of prolactin excess, although its implications on bone health, metabolism and immune system are also expanding. Treatment mainly aims at restoration and maintenance of normal gonadal function/fertility, and prevention of osteoporosis; further specific management strategies depend on the underlying cause. In this review, we provide an update on the diagnostic and management approaches for the patient with hyperprolactinaemia and on the current data looking at the impact of high prolactin on metabolism, cardiovascular and immune systems.

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Section: Surgerymentioning

confidence: 99%

Hyperprolactinaemia

Samperi

Lithgow

Karavitaki

2019

JCM

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“…Although PRL levels may correlate with tumor size, they do not correlate well with symptoms of hyperprolactinemia until higher PRL levels are reached [6,10].…”

Section: Discussionmentioning

confidence: 98%

“…Exceptions are seen in the treatment of macroadenomas with varying results. Although PRL levels may correlate with tumor size, they do not correlate well with symptoms of hyperprolactinemia until higher PRL levels are reached [ 6 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

Atypical Giant Suprasellar Prolactinoma Presenting With Visual Field Changes in the Absence of Symptoms of Hyperprolactinemia

Sun¹,

Mo²,

Levy³

et al. 2021

Cureus

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Prolactinomas are benign tumors that make up the majority of all pituitary adenoma cases and present most commonly in women. Prolactinomas presenting in adolescents and children, however, are extremely rare. We report a case of a 17-year-old male who presented with a six-month history of headaches and a previously unrecognized visual field deficit on examination. Neuroimaging revealed a large suprasellar tumor with imaging, more characteristic of a craniopharyngioma or suprasellar low-grade glioma impinging, on the left intracranial optic nerve causing right-sided hemianopsia. Due to the extensive mass effect and bitemporal hemianopsia on examination, the decision to proceed with initial surgical debulking was made following informed consent. A subtotal resection was performed where the pathology was consistent with a prolactinoma that correlated with markedly elevated prolactin (PRL) levels obtained pre and post-operatively that have not resulted until five days post procedure. The patient was subsequently treated with dopamine agonist (DA) cabergoline therapy and is now five-years disease-free with normal neurological examination and no residual tumor on neuroimaging. DA therapy has shown high clinical efficacy and should be considered prior to any surgical intervention; however, extensive mass effect may appropriate surgical debulking to increase therapy efficacy. Our case highlights an atypical appearance of a giant prolactinoma that may mimic other more common suprasellar tumors, a presentation associated with unrecognized visual field deficits, and the importance of rapid turnaround testing for serum PRL that may aid in the upfront diagnosis and management of prolactinomas.

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“…Although prolactinomas can be removed by a frontal or a butterfly pathway, it is often difficult to completely excise and postoperative serum prolactin levels are difficult to recover. A previous study reported that 40–80% surgeries will result in temporary improvement and half of them will relapse (8). Thus, a novel treatment strategy with improved efficacy or fewer side effects is needed.…”

Section: Introductionmentioning

confidence: 99%

Identification of driver genes and key pathways of prolactinoma predicts the therapeutic effect of genipin

Zhong

Wang

et al. 2019

Mol Med Report

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The purpose of the present study was to identify the potential targets and markers for diagnosis, therapy and prognosis in patients with prolactinoma at the molecular level and to determine the therapeutic effects of genipin in prolactinoma. The gene expression profiles of GSE2175, GSE26966 and GSE36314 were obtained from the Gene Expression Omnibus database. The differentially expressed genes (DEGs) were identified after comparing between gene expression profiles of the prolactinoma tissues and normal tissues. Then, Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis and protein-protein interaction (PPI) network analysis were conducted. In addition, in vitro , scratch assay, colony-forming assay, Cell Counting Kit 8 (CCK8) assay and flow cytometry were performed to verify the functional effects of genipin. An aggregate of 12,695, 3,847 and 5,310 DEGs were identified from GSE2175, GSE26966 and GSE36314, respectively. The results of GO and KEGG analysis showed that the DEGs significant and important for prolactinoma were mostly involved with ‘spindle pole’ and ‘oocyte meiosis’. A total of 20 genes were selected as hub genes with high degrees after PPI network analysis, including mitogen-activated protein kinase 1 (MAPK1), MYC, early growth response 1 (EGR1), Bcl2 and calmodulin 1 (CALM1). CCK8 assay, colony-forming assay and scratch assay were performed to verify the anti-prolactinoma effect of genipin. The results of flow cytometry showed that apoptosis was increased by genipin. MAPK1, MYC, EGR1, Bcl2 and CALM1 were screened as main hub genes. Genipin upregulated the expression level of EGR1 and p21 (downstream mediator of EGR1) and EGR1, inhibited the proliferation and migration of prolactinoma cells. Genipin is a promising drug for treatment of patients with prolactinoma.

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Management of cystic prolactinomas: a review

Cited by 17 publications

References 16 publications

Hyperprolactinaemia

Hyperprolactinaemia

Atypical Giant Suprasellar Prolactinoma Presenting With Visual Field Changes in the Absence of Symptoms of Hyperprolactinemia

Identification of driver genes and key pathways of prolactinoma predicts the therapeutic effect of genipin

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