Non-surgical management of cystic prolactinomas

Bahuleyan, Biji; Menon, Girish; Nair, Suresh; Rao, B. Madhusudhana; Easwer, H. V.; Krishna, K. Ramesh

doi:10.1016/j.jocn.2009.03.024

Cited by 16 publications

(8 citation statements)

References 11 publications

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“…Cystic macroprolactinomas (Figure 9), which have a smaller amount of lactotroph cells, may present with modest increase in PRL levels, and tend to respond less favorably to dopamine agonist therapy (91). Once the possibility of falsely low PRL levels is excluded, any PRL value < 100 ng/mL in a patient harboring a pituitary macroadenoma is therefore highly suggestive of a pseudoprolactinoma (3,4,85).…”

Section: Resultsmentioning

confidence: 99%

Challenges and pitfalls in the diagnosis of hyperprolactinemia

Vilar

Fleseriu

Bronstein

2014

Arq Bras Endocrinol Metab

112

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The definition of the etiology of hyperprolactinemia often represents a great challenge and an accurate diagnosis is paramount before treatment. Although prolactin levels > 200-250 ng/mL are highly suggestive of prolactinomas, they can occasionally be found in other conditions. Moreover, as much as 25% of patients with microprolactinomas may present prolactin levels < 100 ng/mL, which are found in most patients with pseudoprolactinomas, drug-induced hyperprolactinemia, or systemic diseases. On the other hand, some conditions may lead to falsely low PRL levels, particularly the so-called hook effect, that is an assay artifact caused by an extremely high level of PRL, and can be confirmed by repeating assay after a 1:100 serum sample dilution. The hook effect must be considered in all patients with large pituitary adenomas and PRL levels within the normal range or only modestly elevated (e.g., < 200 ng/mL). An overlooked hook effect may lead to incorrect diagnosis and unnecessary surgical intervention in patients with prolactinomas. Another important challenge is macroprolactinemia, a common finding that needs to be identified, as it usually requires no treatment. Although most macroprolactinemic patients are asymptomatic, many of them may present galactorrhea or menstrual disorders, as well as neuroradiological abnormalities, due to the concomitance of other diseases. Finally, physicians should be aware that pituitary incidentalomas are found in at least 10% of adult population. Arq Bras Endocrinol Metab. 2014;58(1):9-22 Keywords Hyperprolactinemia; diagnostic pitfalls; hook effect; macroprolactinemia; pituitary incidentalomas RESUMO A definição da etiologia da hiperprolactinemia muitas vezes representa um grande desafio e um diagnóstico preciso é fundamental antes do tratamento. Embora níveis de prolactina > 200-250 ng/mL sejam altamente sugestivos de prolactinomas, ocasionalmente podem ser encontrados em outras condições. Além disso, até 25% dos pacientes com microprolactinomas podem apresentar-se com níveis de prolactina < 100 ng/mL, os quais são evidenciados na maioria dos pacientes com pseudoprolactinomas, hiperprolactinemia induzida por drogas ou doenças sistêmicas. Por outro lado, deve--se atentar às condições que podem levar a valores de prolactina falsamente baixos, particularmente o chamado efeito gancho. Este último é um artefato causado por um nível extremamente elevado de PRL e que pode ser confirmado pela repetição do exame após diluição do soro a 1:100. O efeito gancho deve ser considerado em todo paciente com grandes adenomas hipofisários e níveis de prolactina dentro da faixa normal ou apenas moderadamente elevados (p. ex., < 200 ng/mL). Um efeito gancho não detectado pode levar a diagnóstico incorreto e intervenção cirúrgica desnecessária em pacientes com prolactinomas. Outro desafio importante é a macroprolactinemia, um achado comum que precisa ser identificado visto que geralmente não requer tratamento. Ainda que a maioria dos pacientes seja assintomática devido à concomitância de outr...

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Section: Resultsmentioning

confidence: 99%

Challenges and pitfalls in the diagnosis of hyperprolactinemia

Vilar

Fleseriu

Bronstein

2014

Arq Bras Endocrinol Metab

112

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“…Prospective randomized control trials have not yet been performed to delineate whether surgical or medical interventions or a combination of both afford patients with cystic prolactinomas the best outcome. However, some small studies show positive responses to medical therapy alone (5). For instance, Bahuleyan et al (5) demonstrated that in a group of 6 patients with cystic prolactinomas treated solely with dopamine agonists, at final follow-up (average of 4.75 years after initiation of bromocriptine), 3 patients had both hormonal and radiologic cure and 3 had reduction in the size of the tumor.…”

Section: Discussionmentioning

confidence: 99%

“…However, some small studies show positive responses to medical therapy alone (5). For instance, Bahuleyan et al (5) demonstrated that in a group of 6 patients with cystic prolactinomas treated solely with dopamine agonists, at final follow-up (average of 4.75 years after initiation of bromocriptine), 3 patients had both hormonal and radiologic cure and 3 had reduction in the size of the tumor. The main limitation to these studies is the small number of subjects.…”

Section: Discussionmentioning

confidence: 99%

Cystic Prolactinoma: A Surgical Disease?

Bhavsar¹,

Silver²

2019

AACE Clinical Case Reports

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Objective: Since the advent of dopamine agonists, prolactinomas have been primarily treated medically. However, studies show conflicting data on whether these agents are as effective as surgery for predominantly cystic prolactinomas. We present a case of a patient with a cystic prolactinoma for which surgery was selected as first-line therapy. Methods: Literature review. Results: A 26-year-old African American man presented to an outside hospital with complaints of dull right-sided headaches for 1 week. The headache worsened over the next few days, which prompted him to go to the emergency room. The evaluation included a head computed tomography, which demonstrated a 4-cm solid/cystic pituitary mass with possible hemorrhagic conversion and compression of the optic chiasm. He was transferred to University of Maryland Medical Center for neurosurgical evaluation. He denied symptoms of pituitary hormone excess or deficiency. He denied visual symptoms, though formal visual field testing demonstrated temporal hemianopia. Hormonal evaluation revealed hyperprolactinemia

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“…Type 2 DA receptor is involved in suppression of gastric cancer cell invasion/migration via EGFR/AKT/MMP-13 pathway 36 and in suppression of pituitary tumors via Rho/ROCK/LIMK signaling pathway 37 . Moreover, DA agonists showed effectiveness in shrinking tumor size in both solid 38 and cystic 39 prolactinomas by controlling serum prolactin level 40 . Meanwhile, prolactin has also been demonstrated to be involved in intricate cytokine network of immunity, manifested as regulatory effects on generation of T cells via IL-2/IL-2R interactions and JAK/STAT pathway 41 .…”

Section: Peripheral Da and Tumor Immunitymentioning

confidence: 99%

Potential Roles of Peripheral Dopamine in Tumor Immunity

Zhang¹,

Liu²,

Liao³

et al. 2017

J. Cancer

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Recent years, immunotherapy has turned out to be a promising strategy against tumors. Peripheral dopamine (DA) has important roles in immune system among tumor patients. Accumulated reports demonstrate variable expression and distribution of DA receptors (DRs) in diverse immune cells. Interestingly, peripheral DA also involves in tumor progression and it exerts anticancer effects on immunomodulation, which includes inflammasomes in cancer, function of immune effector cells, such as T lymphocytes, myeloid-derived suppressor cells (MDSCs), tumor-associated macrophages (TAMs) and natural killer (NK) cells. Given the specific immunologic status, DA medication may be a valuable candidate in pancreatic cancer treatment. The major purpose of this review is to discuss the novel potential interactions between peripheral dopamine and tumor immunity.

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Non-surgical management of cystic prolactinomas

Cited by 16 publications

References 11 publications

Challenges and pitfalls in the diagnosis of hyperprolactinemia

Challenges and pitfalls in the diagnosis of hyperprolactinemia

Cystic Prolactinoma: A Surgical Disease?

Potential Roles of Peripheral Dopamine in Tumor Immunity

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