The Mechanism and Pathways of Dopamine and Dopamine Agonists in Prolactinomas

Liu, Xiaoshuang; Tang, Chao; Wen, Guodao; Zhong, Chunyu; Yang, Jin; Zhu, Junhao; Ma, Chiyuan

doi:10.3389/fendo.2018.00768

Cited by 40 publications

(39 citation statements)

References 66 publications

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“…Dopamine agonists (DA) are first line treatment for patients with prolactinoma [25,43,82]. They induce apoptosis, autophagic cell death and paraptosis of lactotrophs through different molecular pathways mediated by D2R, leading to reduced prolactin secretion and tumour shrinkage [92]. Available DAs include bromocriptine, cabergoline, and quinagolide [25,43,82].…”

Section: Dopamine Agonistsmentioning

confidence: 99%

“…Quinagolide is a non-ergot derived D2R agonist with a 22-hour half-life which allows for daily dosing; typical starting doses are 25 mcg daily usually titrated to 75-150 mcg daily [93]. Current guidelines recommend cabergoline to be used as first line over bromocriptine due to its superior efficacy (attributed to greater affinity and selectivity for D2R) and more optimal side effect profile [25,43,82,92]. Improved adherence due to fewer side effects and more convenient dosing schedule are also further advantages [25,92].…”

Section: Dopamine Agonistsmentioning

confidence: 99%

“…Current guidelines recommend cabergoline to be used as first line over bromocriptine due to its superior efficacy (attributed to greater affinity and selectivity for D2R) and more optimal side effect profile [25,43,82,92]. Improved adherence due to fewer side effects and more convenient dosing schedule are also further advantages [25,92]. Results from cumulative studies have demonstrated that DAs result in reduction in tumour size in 20 to 100% (median 62%), resolution of visual field defects in 33 to 100% (median 67%), resolution of amenorrhea in 40 to 100% (median 78%), resolution of infertility in 10 to 100% (median 53%), improvement of sexual function in 6 to 100% (median 57%), resolution of galactorrhoea in 33 to 100% (median 86%), and normalization of PRL in 40 to 100% (median 68%) of the patients [25].…”

Section: Dopamine Agonistsmentioning

confidence: 99%

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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: Dopamine Agonistsmentioning

confidence: 99%

Section: Dopamine Agonistsmentioning

confidence: 99%

Section: Dopamine Agonistsmentioning

confidence: 99%

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Hyperprolactinaemia

Samperi

Lithgow

Karavitaki

2019

JCM

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“…If a pituitary tumor is diagnosed appropriate referral should be made to facilitate multi-disciplinary input and management. If a tumor is <10 mm or not present, treatment should be initiated with a dopamine agonist [52]. If a pregnancy is not achieved within 6 months, treatment with exogenous FSH could be attempted.…”

Section: Anovulatory Womenmentioning

confidence: 99%

Decision points for individualized hormonal stimulation with recombinant gonadotropins for treatment of women with infertility

Lunenfeld

Bilger

Longobardi

et al. 2019

Gynecological Endocrinology

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It is essential that fertility treatment is individualized based on a thorough diagnostic work-up, with treatment tailored to the patients' requirements. This individualization should be kept in mind during the main decision points that occur before and during treatment. Treatment customization must include consideration of both the woman and her partner involved in the process together, including their collective treatment goals. Once treatment goals have been agreed and diagnostic evaluations performed, personalization based on patient characteristics, together with an understanding of treatment goals and patient preferences, enables the selection of appropriate treatments, protocols, products and their dosing. Following treatment initiation, monitoring and adaptation of product and dose can then ensure optimal outcomes. Currently, it is not possible to base treatment decisions on every characteristic of the patient and personalization is based on biomarkers that have been identified as the most relevant. However, in the future, the use of artificial intelligence coupled with continuous monitoring should enable greater individualization and improve outcomes. This review considers the current state-of-the-art related to decision points during individualized treatment of female infertility, before looking at future developments that might further assist in making individualized treatment decisions, including the use of computer-assisted decision making. ARTICLE HISTORY

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“…Prolactinomas (lactotroph adenomas) are the most frequently diagnosed functioning pituitary adenoma (1,2). In healthy individuals, prolactin synthesis and secretion are inhibited by a tonic secretion of dopamine through the portal system, which activates dopamine type 2 (D2) receptors on the lactotroph cells (3,4). Most prolactinomas retain dopamine-induced inhibition of hormone secretion, although some may be resistant (1,5).…”

Section: Introductionmentioning

confidence: 99%

Depression and Impulsivity Self-Assessment Tools to Identify Dopamine Agonist Side Effects in Patients With Pituitary Adenomas

et al. 2020

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Background: Dopamine agonists (DA) are the first line therapy for prolactinoma and symptomatic hyperprolactinemia; use as an adjuvant treatment for acromegaly and Cushing's disease is rare. Some patients develop de novo psychiatric symptoms or have exacerbation of pre-existing conditions during DA therapy. A practical, clinically sensitive depression and impulse control disorders (ICD; particularly hypersexuality and gambling disorders) detection tool is important for identifying at risk patients. The Barratt Impulsivity Scale (BIS-11) and the 9-item Patient Health Questionnaire (PHQ-9) are sensitive in identifying impulsivity and depression. Objective: Detail use of the BIS-11 and PHQ-9 as screening tools for depression and ICD in patients with pituitary disease at a high-volume academic pituitary center. Methods: DA-treated and naïve patients with pituitary disease were included. Patients with a known history of depression or psychiatric disorder were excluded. PHQ-9 standardized interpretation criteria were utilized to classify depression severity. For BIS-11, threshold was established based on previous studies. Statistical analysis was with SPSS version 25. Results: Seventy-six DA-treated and 27 naïve patients were included. Moderate and moderately severe depression were more prevalent in DA-treated patients; severe depression only found in DA-treated patients. A normal BIS-11 score was noted in 76.69%; higher scores (not significant) were noted in DA-treated patients. There was a positive correlation between higher BIS-11 and PHQ-9 scores; higher in DA-treated patients (r = 0.52, p < 0.001) than DA-naïve patients. Patients with BIS-11 scores ≥60 were younger and received lower cumulative DA doses compared to patients with BIS scores <60. There was no association between male sex and BIS-11 ≥60 and male sex did not increase the odds of increased scores (OR = 0.66, CI95% 0.25-1.76, p = 0.41). No significant difference was found for macroadenoma, prolactin levels, testosterone levels, hypogonadism, testosterone replacement in men, and increased impulsivity or depression scores. Hinojosa-Amaya et al. Depression, Impulse-Control; DA-Treated and Naïve Conclusion: Use of PHQ-9 and BIS-11 is practical for routine screening of depression and ICD during outpatient pituitary clinic visits for patients with pituitary disease both naïve to treatment and during DA therapy. We recommend close follow-up after initiation of DA therapy for younger patients, regardless of dose.

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The Mechanism and Pathways of Dopamine and Dopamine Agonists in Prolactinomas

Cited by 40 publications

References 66 publications

Hyperprolactinaemia

Hyperprolactinaemia

Decision points for individualized hormonal stimulation with recombinant gonadotropins for treatment of women with infertility

Depression and Impulsivity Self-Assessment Tools to Identify Dopamine Agonist Side Effects in Patients With Pituitary Adenomas

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